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Cardiac Surgical Procedures in Patients with Cirrhosis

Chapter

Abstract

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with higher mortality and morbidity in patients with cirrhosis. Child–Pugh (CP) classification and model for end-stage liver disease (MELD) score help stratify risk in patients who need cardiac surgery. CP Class A is not associated with higher mortality in patients undergoing cardiac surgery as compared with propensity matched patients without cirrhosis. Cardiac surgery can be considered in select patients with CP Class B though it is associated with higher mortality and morbidity as compared to patients without cirrhosis. Patients with CP Class C have a prohibitively high risk for cardiac surgery with CPB. In these patients, off pump coronary artery bypass grafting (OPCAB), transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair, and transcatheter endovascular aortic repair (TEVAR) may offer a safer solution. All patients with cirrhosis should undergo careful evaluation before elective cardiac surgery by a hepatologist. Sequelae of cirrhosis, like esophageal varices and ascites, should be addressed preoperatively. Careful postoperative management may decrease the risk of bleeding, need for transfusions, prolonged ventilation, and infections. Combined open heart surgery and orthotropic liver transplantation (OLT) is feasible and should be utilized in appropriate cases.

Keywords

Cirrhosis Cardiac surgery Cardiopulmonary bypass Aortic valve replacement Coronary artery bypass grafting 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Heart and Vascular InstituteCleveland ClinicClevelandUSA
  2. 2.Heart and Vascular InstituteCleveland Clinic FloridaWestonUSA

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