The European System for Cardiac Operative Risk Evaluation (EuroSCORE) and The Society of Thoracic Surgeons (STS) score predict operative risk for patients undergoing cardiac surgery, but the sequelae of cirrhosis such as hepatic encephalopathy, ascites, and elevated bilirubin are not factored into these risk scores. The outcomes of this decade-long experience with 109 patients with cirrhosis were sobering: an overall 30-day mortality of 26%, with CHILD B and C patients having a 30-day mortality of 33%. The Child-Pugh classification is calculated based on total bilirubin, serum albumin, prothrombin time (PT)/International Normalized Ratio (INR), presence of ascites, and encephalopathy. CHILD B patients (7–9 points) have significant functional compromise, and CHILD C (10–15 points) patients are decompensated cirrhotics. The authors have demonstrated an improvement in risk stratification by incorporating the Model for Endstage Liver Disease (MELD) into the patient evaluation. The MELD classification is calculated from three values: total bilirubin, creatinine, and INR. Although this scoring system was originally used to determine 90-day mortality in cirrhotic patients after TIPS, it was subsequently extended to risk-stratify patients listed for liver transplantation. This study [1Arif R. Seppelt P. Schwill S. et al.Predictive risk factors for patients with cirrhosis undergoing heart surgery.Ann Thorac Surg. 2012; 94: 1947-1953Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar] highlights the lack of discrimination in our current risk models to predict true operative risk in the presence of cirrhosis. Multivariate analysis revealed that the MELD score had a negative effect on survival that was additive to the risk predicted by EuroSCORE. Shockingly, a cirrhotic patient with normal bilirubin and creatinine and an INR of 1.2 would have a MELD score of 8 and an additional 8.5% predicted risk beyond that predicted by logistic EuroSCORE alone. Although this patient would be considered subclinically cirrhotic, their mortality risk would be greatly increased after cardiac surgery. This study shows that we can improve the accuracy of our predictive risk models by accounting for hepatic function in cirrhotic patients. These patients pose a great clinical challenge, and a fair estimation of cardiac risk is necessary for the patients, family, and relevant health care providers. Predictive Risk Factors for Patients With Cirrhosis Undergoing Heart SurgeryThe Annals of Thoracic SurgeryVol. 94Issue 6PreviewEmpiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome. Full-Text PDF