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World J Hepatol. Apr 18, 2015; 7(5): 753-760
Published online Apr 18, 2015. doi: 10.4254/wjh.v7.i5.753
Influence of cirrhosis in cardiac surgery outcomes
Juan C Lopez-Delgado, Francisco Esteve, Casimiro Javierre, Josep L Ventura, Rafael Mañez, Elisabet Farrero, Herminia Torrado, David Rodríguez-Castro, Maria L Carrio
Juan 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
Casimiro Javierre, Physiological Sciences II Department, Universitat de Barcelona, IDIBELL (Institut d’Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), 08907 Barcelona, Spain
Author contributions: Lopez-Delgado JC, Esteve F, Javierre C, Ventura JL and Mañez R wrote the paper; Farrero E, Torrado H, Rodríguez-Castro D and Carrio ML performed research; all authors approved the final version of the manuscript.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Juan C Lopez-Delgado, Intensive Care Department, Hospital Universitari de Bellvitge, IDIBELL (Institut d’Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), C/Feixa Llarga s/n., L’Hospitalet de Llobregat, 08907 Barcelona, Spain. juancarloslopezde@hotmail.com
Telephone: +34-650-506985 Fax: +34-932-607963
Received: August 28, 2014
Peer-review started: August 29, 2014
First decision: October 14, 2014
Revised: November 10, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: April 18, 2015
Processing time: 234 Days and 12.4 Hours
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.

Keywords: Liver cirrhosis; Cardiac surgery; Outcomes; Coagulopathy; Nutritional status; Adaptive immune dysfunction; Cirrhotic cardiomyopathy

Core tip: Cardiovascular risk factors are the same for the development of cardiomyopathy and chronic liver disease. Despite cirrhosis is not a recognized risk factor within the risk scores for cardiac surgery, it is well known that its pathophysiological characteristics have the potential for a higher surgical risk and poor prognosis in the perioperative course. In addition, these types of patients are increasingly considered for cardiac surgery. Thus, there is a challenge in order to improve the outcome of these patients based on advances in procedures for cardiac surgeons and clinical perioperative management for physicians.