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

Jaundice following cardiac surgery, frequently referred to as “post-pump jaundice,” has been reported since the 1960’s with an incidence of between 3 to 40%. The incidence of jaundice following mitral valve replacement has been reported to be as high as 55%. Jaundice following cardiac surgery has been associated with prolonged mechanical ventilation, prolonged intensive care unit (ICU) stay, and a higher mortality. The causes of jaundice following cardiac surgery include acute cholecystitis, acute pancreatitis, shocked liver, and septic shock. However, a subset of patients develop hepatic dysfunction without an obvious cause. Hepatic dysfunction in these patients is characterized by hyperbilirubinemia with a mild elevation in hepatic transaminases and no evidence of biliary obstruction on imaging. This entity has been referred to as the “cholestatic post-cardiac surgery syndrome”.