Torben Kehl1, Daniel Biermann2, Andrea Briem-Richter3, Gerhard Schoen4, Jakob Olfe1, Joerg S Sachweh2, Lutz Fischer5, Hansjoerg Schaefer6, Rainer Kozlik-Feldmann1, Urda Gottschalk1. 1. Department for Pediatric Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Cardiac Surgery for Congenital Heart Disease, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Department of Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
Patients undergoing complex pediatric cardiac surgery in early infancy are at risk of postoperative secondary end-organ dysfunction. The aim of this study was to determine specific risk factors promoting the development of peri- and postoperative hepatopathy after surgery for congenital heart disease. In this retrospective study, we identified 20 consecutive patients operated between 2011 and 2019 from our institutional cohort who developed significant postsurgical hepatic dysfunction. These patients were compared to a control group of 30 patients with comparable initial cardiac conditions and STS-EACTS risk score. Patients who developed hepatopathy in the intensive care unit have chronic cholestasis and decreased liver synthesis. The impact of postoperative hepatopathy on morbidity was marked. In six patients (30%), liver transplantation was executed as ultima ratio, and two (10%) were listed for liver transplantation. The overall mortality related to postoperative hepatopathy is high: We found nine patients (45%) having severe hepatopathy and mostly multiple organ dysfunction who died in the postoperative course. According to risk analysis, postoperative right and left heart dysfunction in combination with a postoperative anatomical residuum needing a re-operation or re-intervention in the postoperative period is associated with a high risk for the development of cardiac hepatopathy. Furthermore, postoperative complications (pleural effusion, heart rhythm disorders, etc.), postoperative infections, and the need for parenteral nutrition also raise the risk for cardiac hepatopathy. Further investigations are needed to reduce hepatic complications and improve the general prognosis of such complex patients.
Patients undergoing complex pediatric cardiac surgery in early infancy are at risk of postoperative secondary pan class="Disease">end-organ dysfunction. The aim of this study was to determine specific risk factors promoting the development of peri- and postoperative hepatopathy after surgery for congenital heart disease. In this retrospective study, we identified 20 consecutive patients operated between 2011 and 2019 from our institutional cohort who developed significant postsurgical hepatic dysfunction. These patients were compared to a control group of 30 patients with comparable initial cardiac conditions and STS-EACTS risk score. Patients who developed hepatopathy in the intensive care unit have chronic cholestasis and decreased liver synthesis. The impact of postoperative hepatopathy on morbidity was marked. In six patients (30%), liver transplantation was executed as ultima ratio, and two (10%) were listed for liver transplantation. The overall mortality related to postoperative hepatopathy is high: We found nine patients (45%) having severe hepatopathy and mostly multiple organ dysfunction who died in the postoperative course. According to risk analysis, postoperative right and left heart dysfunction in combination with a postoperative anatomical residuum needing a re-operation or re-intervention in the postoperative period is associated with a high risk for the development of cardiac hepatopathy. Furthermore, postoperative complications (pleural effusion, heart rhythm disorders, etc.), postoperative infections, and the need for parenteral nutrition also raise the risk for cardiac hepatopathy. Further investigations are needed to reduce hepatic complications and improve the general prognosis of such complex patients.
Authors: Matthew C Schwartz; Lisa Sullivan; Meryl S Cohen; Pierre Russo; Anitha S John; Rong Guo; Marta Guttenberg; Elizabeth B Rand Journal: J Thorac Cardiovasc Surg Date: 2011-09-28 Impact factor: 5.209
Authors: Selma O Algra; Nicolaas J G Jansen; Ingeborg van der Tweel; Antonius N J Schouten; Floris Groenendaal; Mona Toet; Wim van Oeveren; Ingrid C van Haastert; Paul H Schoof; Linda S de Vries; Felix Haas Journal: Circulation Date: 2013-10-20 Impact factor: 29.690
Authors: Silke Leonhardt; Wilfried Veltzke-Schlieker; Andreas Adler; Eckart Schott; Roland Hetzer; Walter Schaffartzik; Michael Tryba; Peter Neuhaus; Daniel Seehofer Journal: Crit Care Date: 2015-03-31 Impact factor: 9.097