摘要
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.
Liver cirrhosis has evolved an important risk factor forcardiac surgery due to the higher morbidity and mortalitythat these patients may suffer compared with generalcardiac surgery population. The presence of contributingfactors for a poor outcome, such as coagulopathy, apoor nutritional status, an adaptive immune dysfunction,a degree of cirrhotic cardiomyopathy, and a degree ofrenal and pulmonary dysfunction, have to be taken intoaccount for surgical evaluation when cardiac surgery isneeded, together with the degree of liver disease and itsprimary complications. The associated pathophysiologicalcharacteristics that liver cirrhosis represents have a greatinfluence in the development of complications duringcardiac surgery and the postoperative course. Despitethe population of cirrhotic patients who are referredfor cardiac surgery is small and recommendations comefrom small series, since liver cirrhotic patients haveincreased their chance of survival in the last 20 years dueto the advances in their medical care, which includes livertransplantation, they have been increasingly consideredfor cardiac surgery. Indeed, there is an expected rise ofcirrhotic patients within the cardiac surgical populationdue to the increasing rates of non-alcoholic fatty liverdisease and non-alcoholic steatohepatitis, especiallyin western countries. In consequence, a more specificapproach is needed in the assessment of care of thesepatients if we want to improve their management. Inthis article, we review the pathophysiology and outcomeprediction of cirrhotic patients who underwent cardiacsurgery.
