Role of cardiovascular intervention as a bridge to liver transplantation

摘要

End stage liver disease(ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may pro-foundly influence diagnostic and management strate-gies in the preoperative period. This review focuses on evidence-based diagnosis and management of coro-nary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifi-cally, we address the underlying prevalence of cardio-vascular disease states in the ESLD population, and relevant diagnostic criteria thereof. We highlight tradi-tional and non-traditional predictors of cardiovascular outcomes following liver transplant, as well as data to guide risk-factor based diagnostic strategies. We go on to discuss the alterations in cardiovascular physiology which influence positive- and negative-predictive values of standard noninvasive testing modalities in the ESLD population, and review the data regarding the safetyand efficacy of invasive testing in the face of ESLD and its co-morbidities. Finally, based upon the totality of available data, we outline an evidence-based ap-proach for the management of ischemia, heart failure and pulmonary vascular disease in this population. It is our hope that such evidence-driven strategies can be employed to more safely bridge appropriate candidates to liver transplant, and to improve their cardiovascular health and outcomes in the peri-operative period.