Jaundice Following Open-Heart Surgery

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Abstract
Of 736 open-heart procedures at the University of Oregon Medical School Hospital from 1958 to Oct. 1, 1965, 63 patients had postoperative jaundice. Fifty-eight of these had operations for acquired heart disease and 5 (all adults) for congenital heart disease. The incidence and severity of postoperative jaundice increased with the degree of valvular involvement. There were 2 deaths from massive centrilobular hepatic necrosis. The pattern of bilirubinemia fell into an early group in which jaundice appeared early and receded rapidly and a late group in which hepatic dysfunction appeared at about 2 weeks postoperatively and progressed rapidly. Jaundice of the early group may be related to intrahepatic cholestasis. Attempts to correlate the level of postoperative hyperbilirubinemia with various factors in the operative experience were unrewarding. Probably many different factors contribute to postoperative jaundice. Of possible etiologic agents, halothane and shock seemed most relevant. The effect of shock and vasopressors on hepatic blood flow is discussed in relation to the characteristic pathologic findings of centrilobular hepatic necrosis.

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