The incidence of chronic liver diseases and cirrhosis is steadily increasing. It is therefore common that patients with advanced liver dysfunction are addressed for cardiac surgery interventions. Risk score models specifically developed for cardiac surgery to assess a patient’s surgical candidacy based on the potential unfavourable outcome fail to include all major factors that may render patients at higher risk for surgery. Advanced liver dysfunction is among the excluded factors and for a cardiac surgeon it is problematic to distinguish patients who may benefit from cardiac surgery from those whose perioperative risk exceeds benefit. Consequently, for patients with advanced liver dysfunction, the operative benefit needs to be carefully weighted after a specific assessment and the therapeutic management adapted to the particular clinical picture of the individual patient. The aims of this chapter are to reveal the impact of the pathophysiological changes induced by advanced liver dysfunction on the surgical and anaesthetic outcomes in cardiac surgery and to outline the particular aspects of the pre, intra and postoperative management used to optimize the outcome in this group of patients.
KeywordsAdvanced liver dysfunction Cirrhosis Cardiac surgery Cardiopulmonary bypass Risk scores Outcome Endovascular treatment
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