Cardiac Surgery in Patients with Liver Cirrhosis (CASTER) study: early and long-term outcomes

Background patients with liver cirrhosis (LC) undergoing cardiac surgery (CS) face perioperative high mortality and morbidity, but extensive studies on this topic are lacking. Methods All adult patients with LC undergoing a CS procedure between 2000-2017 at ten Italian Institutions were included in this retrospective cohort study. LC was classified according to preoperative Child-Turcotte-Pugh (CTP) Score and Model for End-Stage Liver Disease (MELD) score. Early and medium-term outcomes analysis was performed in the overall population and according to CTP classes. Results The study population included 144 patients (mean age:66±9 years; male=69%). Ninety-eight, 20 and 26 patients were in CTP class-A, in early (MELD <12) or advanced (MELD >12) CTP class-B respectively. The main LC etiologies were viral (43%) and alcoholic (36%). Liver-related clinical presentation (ascites, esophageal varices and encephalopathy) and laboratory values (EGFR, serum albumin and bilirubin, platelet count) significantly worsened across the CTP-classes(p=.001). CABG or valve surgery (87% bioprosthesis) were performed in 36% and 50% respectively. Postoperative complications (especially AKI, liver complication and LOS) significantly worsened in advanced CTP class-B(p=.001). Notably, observed mortality was 3 or 4-fold higher than the EuroscoreII-predicted mortality, in the overall population, and in the subgroups. At Kaplan-Meier analysis, 1- and 5-years cumulative survival in the overall population was 82±3% and 77±4% respectively. The 5-years survival in CTP class A, early- and advanced-B was 72±5%, 68±11% and 61±10% respectively(p=.238). Conclusions CS outcomes in patients with LC are significantly affected in relation to the extent of preoperative liver dysfunction, but in the early CTP classes medium-term survival is acceptable. Further analysis are needed to better estimate the preoperative risk stratification of these patients.