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.
Highlights
Congenital heart disease (CHD) is the most common congenital defect occurring in approximately 1% of all live births [1]
Secondary sclerosing cholangitis (SSC) first observed in critically ill patients suffering burns or polytrauma newly reported after cardiothoracic surgery associated with prolonged intensive care unit stay is characterized by biliary obstruction, cholestasis, and bile duct necrosis rapidly progressing to cirrhosis
When comparing the hepatopathy (HP) and non-hepatopathy (n-HP) group, no significant differences in preoperative risk factors could be detected
Summary
Congenital heart disease (CHD) is the most common congenital defect occurring in approximately 1% of all live births (excluding bicuspid aortic valve disease) [1]. The underlying mechanisms of hepatic dysfunction are likely multifactorial It is possibly a result of central venous congestion and low cardiac output resulting in tissue hypoxemia [14]. Secondary sclerosing cholangitis (SSC) first observed in critically ill patients suffering burns or polytrauma newly reported after cardiothoracic surgery associated with prolonged intensive care unit stay is characterized by biliary obstruction, cholestasis, and bile duct necrosis rapidly progressing to cirrhosis. It is becoming increasingly more diagnosed and described in recent literature [15,16,17]. A main pathomechanism of SSC might be a prolonged postoperative low cardiac output leading to insufficient oxygen delivery to the biliary epithelium, which is much more susceptible to ischemia than hepatocytes having dual blood supply [18, 19]
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