Cardiac surgery in patients with end-stage liver disease

摘要

ANESTHETIC MANAGEMENT of a patient with end-stage liver disease (ESLD) undergoing major cardiac surgery remains a significant clinical challenge. Morbidity typically results from sepsis, multisystem organ failure, or hepatic insufficiency. Previous limitations to only emergency indications have been relaxed, resulting in an increase in the incidence of major cardiac surgery in patients with ESLD. A review of the New York State Department of Health Cardiac Surgery Registry from 1998 through 2006 showed a 22% increase in the performance of cardiac surgical procedures in patients with known liver disease.This occurred despite liver disease being identified within this registry as a highly significant, independent predictor of poor outcome.