[Cardiac surgery in patients with liver dysfunction; preoperative assessment, determinants, and consequences]

The population of patients with liver cirrhosis and congestive liver who are referred for cardiac operation is not large and definitive indications for surgical interventions remain unknown. We reviewed the literature on its clinical features and outcomes after cardiac surgery that would help cardiac surgeons to decide cardiac modality. According to our experiences, in cirrhotic patients, cardiac surgery can be performed safely in Child-Pugh class A and selected patients with class B. In addition, liver cirrhosis causes postoperative deterioration of liver function, especially when the indocyanine green (ICG)-R15 value exceeds 40%. Technetium-99m galactosyl human serum albumin liver scintigraphy is also useful for preoperative assessment. In patients with congestive liver, preoperative serum total bilirubin and technetium-99m galactosyl human serum albumin liver scintigraphy may become the determinant of indications. Careful patient selection and intensive perioperative care are required to improve the clinical outcome in patients with liver dysfunction undergoing cardiac surgery.