Hyperbilirubinemia After Open Cardiac Surgery

Background: Postoperative hyperbilirubinemia is one of the complications of cardiopulmonary bypass. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac surgery, to analyze the determinants, and to identify the clinical significance of this complication with regard to the associated morbidity and mortality. Methods: This prospective, descriptive study was conducted on 600 patients between 2014 and 2015 in Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. Six hundred adult patients candidated for open heart surgery were divided into 3 groups. Group A comprised 200 patients who underwent coronary artery bypass grafting (CABG), Group B 200 patients who underwent aortic valve replacement (AVR)+CABG, and Group C 200 patients who underwent mitral valve replacement (MVR)+CAB. Aminotransferases (ALT and AST), alkaline phosphatase, and both types of bilirubin (total bilirubin and indirect bilirubin) were determined at admission. Liver funct ion tests were conducted preoperatively, immediately after surgery, and on the 1st, 3rd, and 7th postoperative days . These data were categorized and analyzed. The presence of jaundice was associated with elevated serum bilirubin levels above 3 mg/dL. Results: Hyperbilirubinemia developed in 150 (25%) patients. The incidence of postoperative jaundice was higher in the patients who underwent MVR+CABG than in those who underwent CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary bypass time (P<0.001), aortic cross-clamp time (P<0.001), hypotension during the pump (P<0.001), and number of blood transfusions. Conclusions: Although hyperbilirubinemia seems to be multifactorial, the type of surgery, cardiopulmonary bypass time, aortic cross-clamp time, hypotension during the pump, and number of blood transfusions seem to determine the incidence of jaundice.