Outcome of coronary artery bypass in patients with child-pugh class a liver cirrhosis

Abstract

Postoperative course of CABG in liver cirrhotic patients had a lot of complications like bleeding, hepatic de-compensation, multi organ failure and infection. Which increase the risk morbidity and mortality. A retrospective study from 2007 to 2011 to evaluate the early postoperative outcome of elective CABG in 59 patients with class A cirrhosis. Exclusion criteria are: 1- Class B and C Child Pugh classification. 2- Emergency CABG. 3- Open heart surgeries rather than single CABG. 4- Patients with ejection fraction below 35%. 5- Renal failure patients on regular dialysis. All preoperative, operative and postoperative data including 3 months follow up after discharge home are collected and analyzed. 59 patients with class A liver failure underwent CABG, 37 male, 22 female.42 hypertensive, 28 diabetics. Mean 1st 24 h chest tube drainage was 853.80 ± 567.10 ml, minimal 130 ml maximum 3500 ml. 12 patients (20.3%) reexplored for bleeding, Mean ventilation time was 10.48 ± 6.65 h. Mean ICU stay was 59.52 ± 13.91 h. Two patients died (3.38%), one patient due to hepato-renal failure (re explored 3 times) the 2nd patient died after delayed recovery due to cerebral hemorrhage. 20 patients (33.89%) had of wound infection two of them need debridement and rewiring. Mean hospital stay was 9.18 ± 2.29days .Total morbidity was (49%). mortality was 4%. CABG can be tolerated satisfactorily in class A Child cirrhotic patients with high incidence of the postoperative complications specially bleeding and wound infection.