Perioperative considerations in patients with cirrhotic cardiomyopathy.
OBJECTIVE
This review aims to identify specific criteria for cirrhotic cardiomyopathy, examine the correlation with perioperative adverse outcomes and explore options for hemodynamic monitoring.


RESULTS
Cirrhotic cardiomyopathy is characterized by an increase in cardiac output, blunted systolic contractile response to stress, diastolic dysfunction and electrophysiological abnormalities. Adverse events due to cirrhotic cardiomyopathy are not as well characterized, but evidence suggests that some cardiovascular complications during surgery and in the postoperative period are caused by an impaired response to physiological stress. New developments in hemodynamic monitoring using not only thermodilution technology provide more reliable information about cardiac performance than pressure-derived measures. Transesophogeal echocardiography also offers the physician new information including the ability to visualize heart structures, shape, and function.


CONCLUSIONS
To detect cirrhotic cardiomyopathy, physicians must conduct a systematic examination of the patient. Overt manifestations of cirrhotic cardiomyopathy often only become evident after a patient is exposed to physiological or drug-induced stress. Appropriate hemodynamic monitoring is a cornerstone in the perioperative management of cirrhotic patients.
Biancofiore
Gianni
G
Anestesia e Rianimazione SSN, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy. g.biancofiore@med.unipi.it
Mandell
Mercedes Susan
MS
Rocca
Giorgio Della
GD
D000758:Anesthesia; D002310:Cardiomyopathy, Alcoholic / Q000150:complications*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008991:Monitoring, Physiologic; D019990:Perioperative Care