Influence of cirrhosis in cardiac surgery outcomes

Table 1 Demographic characteristics of cirrhotic patients undergoing cardiac surgery

Ref.	Country	Age (yr)	Sex (male)	Liver cirrhosis aetiology					Mean MELD/
				Alcohol	Viral (Hep B/Hep C)	PBC/autoinmune	Congestive	Others	mean CTP
Klemperer et al[48]	United States	65 ± 8.3	11 (84.6%)	10	2	1	-	-	NA
Suman et al[49]	United States	63.6 ± 12.6	27 (61.3%)	11	6 (3/3)	2	2	23	11.5 ± 4.2/6.29
Filsoufi et al[9]	United States	58 ± 10	20 (74%)	8	18 (5/13)	1	1	4	14.2 ± 4.2/NA
Lin et al[51]	China	56	14 (77.7%)	5	13	-	-	-	NA/NA
An et al[44]	China	53 ± 13	10 (41.6%)	1	15	-	7	1	NA/NA
Hayashida et al[50]	Japan	64 ± 12	11 (61.1%)	3	12	1	1	1	NA/NA
Murashita et al[52]	Japan	69.9 ± 9.4	5 (41.6%)	NA	NA	NA	NA	NA	NA/6.3
Morisaki et al[45]	Japan	69 ± 8.5	31 (73.8%)	5	27 (1/26)	2	7	7	11.8 ± 6/5.9 ± 1.6
Sugimura et al[55]	Japan	61.1 ± 11.2	11 (84.6%)	4	4 (0/4)	1	1	1	8.6 ± 2.5/6.7 ± 2
Morimoto et al[56]	Japan	69.8 ± 9.4	21 (65%)	7	25 (17/8)	-	-	-	11.5 ± 5.1/7.2 ± 1.9
Thielmann et al[1]	Germany	62 ± 10	38 (66.7%)	NA	NA	NA	NA	NA	13 ± 6/NA
Gundling et al[3]	Germany	65.4 ± 11.7	33 (70.2%)	25	6 (3/3)	1	1	14	NA/NA
Arif et al[54]	Germany	64 ± 10	82 (75.2%)	60	6	3	7	33	11.6 ± 5.1/6.4 ± 1.5
Bizouarn et al[6]	France	58.8 ± 13.9	8 (66.7%)	7	2	2	-	1	NA/NA
Vanhuyse et al[53]	France	65 ± 11	26 (76%)	20	11	2	-	1	12 ± 3.5/NA
Lopez-Delgado et al[5]	Spain	64.9 ± 11.6	10 (69%)	20	30 (4/26)	-	-	8	16 ± 5.4/NA

Hep: Hepatitis; PBC: Primary biliary cirrhosis; MELD: Model for end-stage liver disease; CTP: Child-Turcotte-Pugh; NA: Not available.

Table 2 Demographic characteristics of liver cirrhosis aetiologies by region

Region	LC etiology					Total
	Alcohol	Viral	PBC/autoinmune	Congestive	Others
United States	29 (32.6%)	26 (29.2%)	4 (4.5%)	3 (3.4%)	27 (30.3%)	89
China	6 (14.3%)	28 (66.6%)	-	7 (16.8%)	1 (2.3%)	42
Japan	19 (17.4%)	68 (62.4%)	4 (3.6%)	9 (8.3%)	9 (8.3%)	109
Germany	75 (51%)	12 (8.2%)	4 (2.7%)	9 (6.1%)	47 (32%)	147
France	27 (60%)	13 (28.8%)	4 (9%)	-	1 (2.2%)	45
Spain	20 (34.5%)	30 (51.7%)	-	-	8 (13.8%)	58
Total (EU)	122 (48.8%)	55 (22%)	8 (3.2%)	9 (3.6%)	56 (22.4%)	250
Total (Asia)	25 (16.5%)	96 (63.5%)	4 (2.6%)	16 (10.8%)	10 (6.6%)	151

PBC: Primary biliary cirrhosis; LC: Liver cirrhosis.

Table 3 Postoperative complications of cirrhotic patients undergoing cardiac surgery

Ref.	Morbidities	RI-AKI	RRT needs	Sepsis	Pulmonary	Bleeding	Liver
Klemperer et al[48]	44% (7)	23% (3)	-	38% (5)	30% (4)	30% (4)	23% (3)
Suman et al[49]	-	13% (6)	-	11% (5)	-	-	27% (12)
Filsoufi et al[9]	52% (14)	15% (4)	15% (4)	18% (5)	22% (6)	7% (2)	15% (4)
Lin et al[51]	50% (9)	5% (1)	-	22% (4)	6% (1)	22% (4)	11% (2)
An et al[44]	75% (18)	29% (7)	-	17% (4)	29% (7)	25% (6)	12% (3)
Hayashida et al[50]	66.7% (12)	28% (5)	-	33% (6)	28% (5)	17% (3)	22% (4)
Murashita et al[52]	75% (9)	-	-	-	-	-	-
Morisaki et al[45]	31.7% (13)	-	-	-	-	-	-
Sugimura et al[55]	77% (10)	15% (2)	15% (2)	23% (3)	15% (2)	-	8% (1)
Morimoto et al[56]	53% (17)	9% (3)	-	9% (3)	29% (10)	26% (9)	11% (4)
Thielmann et al[1]	-	39% (22)	39% (22)	9% (5)	-	28% (16)	14% (8)
Arif et al[54]	> 50%	53% (58)	24% (26)	58% (63)	9% (10)	-	-
Bizouarn et al[6]	58% (7)	-	-	25% (3)	-	-	33% (4)
Vanhuyse et al[53]	-	21% (7)	-	50% (17)	9% (3)	18% (6)	12% (4)
Lopez-Delgado et al[5]	43.1% (25)	79% (46)	9% (5)	21% (12)	-	2% (1)	-
Ranges	31%-77%	5%-79%	9%-39%	11%-58%	6%-30%	2%-30%	8%-23%

RI-AKI: Renal insufficiency or acute kidney injury; RRT: Renal replacement therapies.

Table 4 Mortality¹ causes of cirrhotic patients undergoing cardiac surgery

Ref.	Liver	Sepsis	Bleeding	Cardiovascular	Other
Klemperer et al[48]	4
Filsoufi et al[9]	3	2	1		1-Bowel ischaemia
Lin et al[51]	1
An et al[44]		5	1
Hayashida et al[50]	1	2			1
Sugimura et al[55]	1
Morimoto et al[56]	1	2	2		2
Thielmann et al[1]	8	5	1	2	1-Bowel ischaemia
Gundling et al[3]	2	2		3	2
Bizouarn et al[6]	1
Vanhuyse et al[53]	4	3			1; 1-Bowel ischaemia
Lopez-Delgado et al[5]	1	6
Total	38.5% (27)	38.5% (27)	7.1% (5)	7.1% (5)	8.6% (6)

¹Thirty-day mortality or in-hospital mortality.

Table 5 Operative characteristics of cirrhotic patients undergoing cardiac surgery

Ref.	Mean CPB (min)	Urgent-emergent	Type of surgery
			CABG	Valve surgery	CABG + valve	Aortic	Other	Off pump (% mortality)
Klemperer et al[48]	102	9 (69.2%)	6	4	3	-	-	-
Suman et al[49]	114 ± 48	1 (2.3%)	16	16	10	-	2	-
Filsoufi et al[9]	142 ± 68	4 (15%)	8	12	-	3	4	5 (0%)
Lin et al[51]	138	-	4	13	1	-	-	2
An et al[44]	160 ± 53	7 (29.1%)	2	19	2	1	-	-
Hayashida et al[50]	151 ± 63	3 (16.7%)	6	9	1	1	1	3 (0%)
Murashita et al[52]	147 ± 41	0	3	9	-	-	-	2
Morisaki et al[45]	157 ± 50	7 (16.7%)	11	20	5	2	4	5
Sugimura et al[55]	242 ± 77	6 (46.1%)	1	7	1	3	1	3
Morimoto et al[56]	145 ± 98	7 (22%)	6	18	2	6	-	6
Thielmann et al[1]	125 ± 55	10 (18%)	24	11	19	-	3	2
Gundling et al[3]	101 ± 43	-	21	14	9	-	3	-
Arif et al[54]	-	23 (21%)	55	36	10	2	6	-
Bizouarn et al[6]	85	-	1	10	2	-	-	-
Vanhuyse et al[53]	100 ± 66	2 (6%)	13	20	-	-	-	1
Lopez-Delgado et al[5]	107 ± 37	3 (5.1%)	9	42	7	-	-	6 (0%)

CPB: Cardiopulmonary bypass; CABG: Coronary artery bypass graft.