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Surgical Procedures on the Cirrhotic Patient pp 243–252Cite as

Cardiac Surgical Procedures in Patients with Cirrhosis

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Abstract

Cardiac surgery with cardiopulmonary bypass (CPB) is associated with higher mortality and morbidity in patients with cirrhosis. Child–Pugh (CP) classification and model for end-stage liver disease (MELD) score help stratify risk in patients who need cardiac surgery. CP Class A is not associated with higher mortality in patients undergoing cardiac surgery as compared with propensity matched patients without cirrhosis. Cardiac surgery can be considered in select patients with CP Class B though it is associated with higher mortality and morbidity as compared to patients without cirrhosis. Patients with CP Class C have a prohibitively high risk for cardiac surgery with CPB. In these patients, off pump coronary artery bypass grafting (OPCAB), transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair, and transcatheter endovascular aortic repair (TEVAR) may offer a safer solution. All patients with cirrhosis should undergo careful evaluation before elective cardiac surgery by a hepatologist. Sequelae of cirrhosis, like esophageal varices and ascites, should be addressed preoperatively. Careful postoperative management may decrease the risk of bleeding, need for transfusions, prolonged ventilation, and infections. Combined open heart surgery and orthotropic liver transplantation (OLT) is feasible and should be utilized in appropriate cases.

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Author information

Authors and Affiliations

  1. Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH, 44195, USA

    Ahmad Zeeshan MD & Nicholas Smedira MD

  2. Heart and Vascular Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Desk 23-24, Weston, FL, 33331, USA

    Ahmad Zeeshan MD & Nicholas Smedira MD

Authors
  1. Ahmad Zeeshan MD
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  2. Nicholas Smedira MD
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Correspondence to Nicholas Smedira MD .

Editor information

Editors and Affiliations

  1. Transplantation Center, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA

    Bijan Eghtesad

  2. Department of Surgery, University of Chicago, Chicago, Illinois, USA

    John Fung

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Zeeshan, A., Smedira, N. (2017). Cardiac Surgical Procedures in Patients with Cirrhosis. In: Eghtesad, B., Fung, J. (eds) Surgical Procedures on the Cirrhotic Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-52396-5_19

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  • DOI: https://doi.org/10.1007/978-3-319-52396-5_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52394-1

  • Online ISBN: 978-3-319-52396-5

  • eBook Packages: MedicineMedicine (R0)

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