Influence of cirrhosis in cardiac surgery outcomes.
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.
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.
Juan C
JC
Lopez-Delgado
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.
Francisco
F
Esteve
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
C
Javierre
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.
Josep L
JL
Ventura
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.
Rafael
R
Mañez
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.
Elisabet
E
Farrero
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.
Herminia
H
Torrado
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.
David
D
Rodríguez-Castro
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.
Maria L
ML
Carrio
Adaptive immune dysfunction; Cardiac surgery; Cirrhotic cardiomyopathy; Coagulopathy; Liver cirrhosis; Nutritional status; Outcomes