Incidence and prognostic importance of jaundice after cardiopulmonary bypass surgery.

In a prospective study of 248 consecutive patients undergoing cardiopulmonary bypass surgery, early postoperative "post-pump" jaundice (PPJ) developed in 49 (20%). Development of PPJ was strongly associated with a bad outcome; 25% of jaundiced patients and 1% of non-jaundiced patients died in the postoperative period. The jaundice was a conjugated hyperbilirubinaemia, and was detectable in 48 out of 49 patients by postoperative day 2. Hypotension, hypoxia, and hypothermia ("shocked liver") were not associated with the development of PPJ, nor was evidence of haemolysis or heart-failure. Although PPJ was significantly associated with multiple valve replacement, higher transfusion requirements, and longer cardiopulmonary bypass time, it also occurred in patients undergoing uncomplicated operations. It is suggested that PPJ is caused by a defect in hepatic excretion of bilirubin.