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Hyperbilirubinemia After Cardiopulmonary Bypass: A Prospective Study

Department of Cardiovascular & Thoracic Surgery India 1 Department of Transfusion Medicine India 2 Department of Biochemistry Sri Venkateswara Institute of Medical Sciences Tirupati, Andhra Pradesh, India

For reprint information contact: Abha Chandra, MCh Tel: 91 8574 51222 Ext. 2378 Fax: 91 8574 28803 email: svims{at}ap.ap.nic.in Department of Cardiovascular & Thoracic Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, AP 517507, India.

Postoperative hyperbilirubinemia is one of the complications of cardiopulmonary bypass. This prospective study was conducted on 77 patients who underwent open-heart surgery, to evaluate the incidence, risk factors, and prognostic significance of postoperative hyperbilirubinemia. Liver function tests were conducted preoperatively, immediately after surgery and on the 1st, 3rd, and 7th postoperative days. The overall incidence of postoperative hyperbilirubinemia was 26%. The incidence was significantly higher in patients who underwent prosthetic valve replacements (31%) than in those without prostheses (22%) and very high in patients undergoing double valve replacement (50%) compared to single valve replacement (27%). Most (90%) of the increase in serum bilirubin was due to a rise in unconjugated bilirubin on the 1st postoperative day. There was no mortality related to postoperative hyperbilirubinemia but it prolonged intensive care stay when it occurred early after surgery and prolonged hospital stay when it occurred later. Preoperative total bilirubin concentration, number of valves to be replaced, and preoperative high right atrial pressure were the factors associated with increased risk of postoperative hyperbilirubinemia by logistic regression analysis.