[Cardiac surgery for patients with liver cirrhosis]

Liver cirrhosis has been shown a major preoperative risk factor in patients undergoing cardiac surgery. Although recent evidence comes from limited studies with relatively small number of patients, morbidity and mortality progressively increase with the severity of liver dysfunction. Patients with Child-Pugh classification B or C have significantly higher risks after open heart surgery using cardiopulmonary bypass. Recently, model for end-stage liver disease (MELD) score more reliably identifies patients who are at higher risk of mortality after open heart surgery. Off pump operation seems beneficial to prevent postoperative mortality and morbidity in patients with moderate to severe liver dysfunction in anecdotally reported cases, but further studies are warranted to prove its effectiveness. Incidence of major morbidity including hemodynamic instability caused by hyperdynamic circulation, systemic fluid retention, infection, and bleeding is high. Preoperative optimization of medical condition by correcting coagulopathy, poor nutrition, fluid retention and renal function is important in patients with high predictive risks. Non-cardiovascular morbidities including malignancies or hepatic decompression are the major limiting factors for long term survival. Careful consideration of expected risks and benefits is required to determine the surgical indication in those patients.