The importance of liver function assessment before cardiac surgery: A narrative review

Area of Science:

• Cardiology
• Hepatology
• Anesthesiology

Background:

• Increasing global demand for cardiac surgery leads to more patients with comorbidities, including liver disease.
• Liver disease, particularly advanced cirrhosis, is linked to heart failure and worse outcomes after cardiac surgery.
• Current cardiac surgery risk scores often neglect liver function, despite its impact on perioperative mortality.

Purpose of the Study:

• To review the pathophysiology of postoperative complications in cardiac surgery patients with liver disease.
• To provide evidence-based recommendations for perioperative management of these high-risk patients.
• To highlight the importance of integrating liver function assessment into preoperative evaluations.

Main Methods:

• Narrative review of existing literature.
• Analysis of pathophysiological links between liver disease and cardiac surgery complications.
• Synthesis of recommendations for clinical practice.

Main Results:

• Patients with liver disease have significantly worse short- and long-term survival after cardiac surgery.
• Liver dysfunction exacerbates cardiovascular risks and complicates surgical management.
• Specific perioperative strategies are needed to mitigate risks.

Conclusions:

• Preoperative evaluation of liver function is essential for risk stratification in cardiac surgery.
• Optimized perioperative management and postoperative follow-up can improve results for patients with liver disease.
• Further research and integration of liver function into risk models are warranted.