Impact of cardiohepatic syndrome on postoperative mortality in heart failure patients with reduced ejection fraction undergoing coronary artery bypass grafting

Cardiohepatic syndrome (CHS) is a parameter used to define liver dysfunction in heart failure patients and has been shown to be associated with poor prognosis. In this study, we investigated the relationship between the presence of preoperative CHS and postoperative mortality in heart failure patients with reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG). We retrospectively included patients who were evaluated in anesthesia outpatient clinic of our hospital before first-time elective isolated CABG and had HFrEF (left ventricular ejection fraction LVEF ≤ 40%) between 2019 and 2023 years. Patients’ demographic, clinical and laboratory parameters were recorded and patients were divided into two according to the presence of CHS. Primary outcome of the study was long-term all-cause mortality. The median follow-up duration was 607 days (interquartile range IQR: 484–773 days). A total of 299 patients with a median age 62 years (IQR: 56–69 years) were enrolled. 80% (n = 240) of the study group were men and CHS was observed in 8% (n = 24) of the patients. All-cause mortality occurred in 50 patients (16.7%) during the follow-up. CHS was more common in mortality (+) group (14% vs. 6.8%, p = 0.049). Presence of CHS was associated with a significant increase in all-cause mortality (adjusted hazard ratio: 2.93; 95% confidence interval: 1.18–7.24; p = 0.02) along with advanced age, high creatinine, low albumin and LVEF values. Presence of preoperative CHS was independently associated with long term all-cause mortality in HFrEF patients undergoing CABG.