Cirrhotic Patients Undergoing Cardiac Surgery: Why Not to Develop a More Specific Heart-Liver Score?

Alessandro Morgante

doi:10.4236/wjcs.2021.111001

Abstract

Despite not included in the traditional risk scores before surgery, liver cirrhosis, especially in advanced stages, has always influenced strongly final outcome both on short and midterm in patients undergoing cardiac surgery. Growing incidence of non-alcoholic fatty liver disease interlinked with metabolic syndrome and significant advancements in medical therapy have actually increased the likelihood of cardiac surgery in cirrhotic patients. To date, Child-Pugh and MELD scores have been commonly used to predict mortality and postoperative hepatic decompensation, but on the other hand, both traditional risk scores show some limitations for evaluation of hepatopathic patients undergoing specifically cardiac surgery. In this context, a specific Heart-Liver score hasn’t been developed yet in the attempt to outline a patient profile able to face surgery, therefore addressing us to adopt the best strategy possible for each case. If CP class A or low MELD score (<11) patients tolerate cardiac surgery with a mild increase in mortality and morbidity, currently state of art recommends particular caution towards surgery idea in presence of advanced hepatic disease. As far as cardiac surgery represents the unique therapeutic strategy in several life-threatening cases, anyway surgical correction of cardiac pathology won’t guarantee an increased life expectancy in accordance with the persistent liver dysfunction. Hereby, this paper will focus on preoperative parameters that should be considered in the future realization of a Heart-Liver prognostic score for overcoming limitations and difficulties related to the impact of liver disease on final clinical outcome.

Highlights

BackgroundWe more and more often may deal with cirrhotic patients having to undergo cardiac surgery, because of growing incidence of non-alcoholic fatty liver disease (NAFLD) and significant advancements in medical therapy (Figure 1), that have improved life expectancy of a cirrhotic patient
Growing incidence of non-alcoholic fatty liver disease interlinked with metabolic syndrome and significant advancements in medical therapy have increased the likelihood of cardiac surgery in cirrhotic patients
Child-Pugh and MELD scores have been commonly used to predict mortality and postoperative hepatic decompensation, but on the other hand, both traditional risk scores show some limitations for evaluation of hepatopathic patients undergoing cardiac surgery

Summary

Background

We more and more often may deal with cirrhotic patients having to undergo cardiac surgery, because of growing incidence of non-alcoholic fatty liver disease (NAFLD) and significant advancements in medical therapy (Figure 1), that have improved life expectancy of a cirrhotic patient. Absence of liver cirrhosis within traditional risk score calculators after cardiac surgery doesn’t rule out clinical dogma that so far an advanced hepatic disease has always influenced strongly final outcome both on short and mid-term. Recent studies have underlined and reinforced the prognostic role of MELD score [1], commonly used together to Child-Pugh (CP) classification in order to predict mortality and postoperative hepatic decompensation (Table 1). MELD score is usually categorized into three functional classes: Low MELD (6 - 14) - Intermediate MELD (15 - 24) - High MELD (25 - 40)

Morgante

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Conclusions