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Published on: April 9, 2016
Influence of cirrhosis in cardiac surgery outcomes
Juan C Lopez-Delgado1, Francisco Esteve1, Casimiro Javierre1
1Juan C Lopez-Delgado, Francisco Esteve, Josep L Ventura, Rafael Mañez, Elisabet Farrero, Herminia Torrado, David Rodríguez-Castro, Maria L Carrio, Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d'Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), 08907 Barcelona, Spain.
Insights
Patients with liver cirrhosis face higher risks during cardiac surgery due to factors like coagulopathy and organ dysfunction. Improved medical care increases their suitability for cardiac procedures, necessitating specialized evaluation.
Area of Science:
- Cardiology
- Hepatology
- Transplantation
Background:
- Liver cirrhosis significantly increases risks for cardiac surgery patients, leading to higher morbidity and mortality.
- Factors like coagulopathy, malnutrition, immune dysfunction, cirrhotic cardiomyopathy, and renal/pulmonary issues complicate surgical outcomes.
- Advances in medical care and liver transplantation have improved survival, increasing the number of cirrhotic patients considered for cardiac surgery.
Purpose of the Study:
- To review the pathophysiology of cardiac surgery in liver cirrhosis patients.
- To discuss outcome prediction for cirrhotic patients undergoing cardiac surgery.
- To highlight the need for a specialized approach in managing these complex patients.
Main Methods:
- Literature review focusing on pathophysiology and outcomes.
- Analysis of risk factors and contributing conditions in cirrhotic patients.
- Examination of current trends and future projections for this patient population.
Main Results:
- Cirrhotic cardiomyopathy, coagulopathy, and multi-organ dysfunction are key predictors of poor outcomes.
- Despite risks, improved survival rates mean more cirrhotic patients are candidates for cardiac surgery.
- Increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis will likely increase this patient cohort.
Conclusions:
- Cardiac surgery in liver cirrhosis patients requires careful evaluation of comorbidities and liver disease severity.
- A tailored approach to pre-operative assessment and post-operative management is crucial for improving outcomes.
- Further research and specific guidelines are needed to optimize the care of cirrhotic patients undergoing cardiac surgery.
Abstract:
Liver cirrhosis has evolved an important risk factor for cardiac surgery due to the higher morbidity and mortality that these patients may suffer compared with general cardiac surgery population. The presence of contributing factors for a poor outcome, such as coagulopathy, a poor nutritional status, an adaptive immune dysfunction, a degree of cirrhotic cardiomyopathy, and a degree of renal and pulmonary dysfunction, have to be taken into account for surgical evaluation when cardiac surgery is needed, together with the degree of liver disease and its primary complications. The associated pathophysiological characteristics that liver cirrhosis represents have a great influence in the development of complications during cardiac surgery and the postoperative course. Despite the population of cirrhotic patients who are referred for cardiac surgery is small and recommendations come from small series, since liver cirrhotic patients have increased their chance of survival in the last 20 years due to the advances in their medical care, which includes liver transplantation, they have been increasingly considered for cardiac surgery. Indeed, there is an expected rise of cirrhotic patients within the cardiac surgical population due to the increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, especially in western countries. In consequence, a more specific approach is needed in the assessment of care of these patients if we want to improve their management. In this article, we review the pathophysiology and outcome prediction of cirrhotic patients who underwent cardiac surgery.
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