Cardiac operations in cirrhotic patients.

It is well recognized that morbidity and mortality rates after cardiac operations with cardiopulmonary bypass in patients with cirrhosis are significantly higher than those in the general cardiac surgical population. Several contributing factors peculiar to cirrhosis, such as compromised nutritional status, increased susceptibility to infections, and impaired coagulopathy, may be responsible for the poor prognosis. It is empirically agreed that cardiac operations using cardiopulmonary bypass are contraindicated in patients with advanced cirrhosis. However, the population of cirrhotic patients who are referred for cardiac operations is still small and definitive indications for surgical interventions remain unknown. Moreover, cirrhotic patients have many distinctive anatomical and physiological features that influence postoperative course considerably. In this article, we reviewed the literature with special reference to its clinical features and clinical outcomes after cardiac surgery that would help cardiac surgeons to decide therapeutic modality. Further understanding of the unique condition, careful patient selection and intensive postoperative care are required to improve the clinical outcome in cirrhotic patients undergoing cardiopulmonary bypass. Recent developments in minimally invasive procedures, such as off-pump coronary artery bypass grafting, however, may enable us to treat patients with advanced cirrhosis safely.