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Critical Care for Potential Liver Transplant Candidates pp 1–23Cite as

Cardiac Evaluation and Management

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Abstract

Cardiovascular assessment is an essential part of the pretransplant evaluation for liver transplantation, as cardiovascular complications are an important cause of perioperative and post-transplant morbidity and mortality. Coronary artery disease is prevalent in the population presenting for liver transplantation, and its presence has been associated with poor outcomes. Identification of occult obstructive coronary artery disease is a major part of the pretransplant evaluation. In addition, structural cardiac processes including valvular disease, cardiomyopathy, arrhythmia, and congenital heart disease may adversely impact outcomes. Recent investigations have focused on determining cardiac risk stratification in liver transplant candidates and elucidating perioperative management strategies to optimize outcomes in transplant candidates with pre-existing cardiac disease. Current coronary artery disease screening recommendations for liver transplant candidates are more heavily weighted on risk factor assessment and noninvasive testing than are those for non-transplant surgical patients. Coronary angiography has an important role in patients with positive noninvasive testing results and may also be indicated in high-risk candidates prior to listing. Management of coronary artery disease is controversial but typically includes percutaneous intervention on significant lesions. Further, perioperative treatment dilemmas are not uncommon, particularly in high-MELD or critically ill candidates. Structural cardiac disease identified via echocardiography and severe arrhythmias require cardiology consultation and possible correction prior to transplant. Programs increasingly rely on dedicated cardiology teams experienced in the pretransplant evaluation of liver transplant candidates. Likewise, liver transplant anesthesia teams provide expertise in the pretransplant evaluation of liver transplant candidates and are crucial in the evaluation of candidates with advanced cardiac disease.

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Authors and Affiliations

  1. Liver Transplant Division, Department of Anesthesiology and Perioperative Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Christopher Wray

  2. Solid Organ Transplant Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

    James Y. Findlay

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Correspondence to James Y. Findlay .

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Editors and Affiliations

  1. Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey, PA, USA

    Dmitri Bezinover

  2. General, Visceral and Transplant Surgery, University of Duisburg-Essen, Essen, Germany

    Fuat Saner

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Wray, C., Findlay, J.Y. (2019). Cardiac Evaluation and Management. In: Bezinover, D., Saner, F. (eds) Critical Care for Potential Liver Transplant Candidates. Springer, Cham. https://doi.org/10.1007/978-3-319-92934-7_1

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