Critical Care and Shock

Natural History and Risk Factors of the “Cholestatic Post-cardiac Surgery Syndrome”

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Objective: To describe the natural history and risk factors of the cholestatic post-cardiac surgery syndrome.

Methods: We reviewed all cases of patients with hyperbilirubinemia after cardiac surgery admitted to a large metropolitan referral hospital during January 2005 to December 2005 (n=317).

Results: Fourteen patients (11 male, 3 female) developed postoperative hyperbilirubinemia after excluding hyperbilirubinemia secondary to acute cholecystitis, acute pancreatitis, and shock. Sixty four percent of patients have mild and subclinical hepatobiliary disease preoperatively. Preoperative echocardiography showed right ventricular enlargement and/or hypokinesis in most patients. The mean serum total bilirubin peaked at postoperative day 9 and return to normal by postoperative day 18. The highest recorded serum total bilirubin was 13 mg/dL (221 μmol/L). The mean serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) levels were mildly elevated and showed no distinct peak during postoperative period.

Conclusion: In this series, 4.4% of patients undergoing cardiac surgery developed idiopathic post-operative jaundice. Preexisting liver disease and increased right heart pressures were associated with this syndrome. After excluding other causes of hyperbilirubinemia, serum total bilirubin can be expected to normalize in first 18 days after surgery.