Cardiac Operations in Patients With Cirrhosis

Klemperer, John D.; Ko, Wilson; Krieger, Karl H.; Connolly, Michelle; Rosengart, Todd K.; Altorki, Nasser K.; Lang, Samuel J.; Isom, O. Wayne

doi:10.1016/s0003-4975(97)00931-4

Cited by 134 publications

(71 citation statements)

References 6 publications

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“…Therefore, the presence of cirrhosis or portal hypertension may adversely influence a patient's candidacy for heart transplantation. [141][142][143][144][145][146] Heart and liver transplantation has been reported in carefully selected patients with Fontan physiology. 147 Preventive strategies include confirmation of hepatitis B immunity in patients who have undergone vaccination previously and immunization for hepatitis A and B for those who are not currently immune.…”

Section: Managementmentioning

confidence: 99%

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lui¹,

Saïdi²,

Bhatt³

et al. 2017

Circulation

180

136

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ABSTRACT:Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.

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Section: Managementmentioning

confidence: 99%

Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lui¹,

Saïdi²,

Bhatt³

et al. 2017

Circulation

180

136

View full text Add to dashboard Cite

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“…Laboratory abnormalities suggestive of synthetic dysfunction are particularly worrisome and should be aggressively investigated. 69,70 Evidence for portal hypertension by noninvasive means, for example, liver-spleen scans or abdominal ultrasound, suggests advanced liver disease but lacks sensitivity for significant hepatic dysfunction, for example, fibrosis. Transjugular intrahepatic liver biopsy can be performed safely in patients with advanced HF.…”

Section: Assessment Of Hepatic Status In Hfmentioning

confidence: 99%

Gastrointestinal and Liver Issues in Heart Failure

2016

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Abstract-Heart failure affects ≈23 million people worldwide and continues to have a high mortality despite advancements in modern pharmacotherapy and device therapy. HF is a complex clinical syndrome that can result in the impairment of endocrine, hematologic, musculoskeletal, renal, respiratory, peripheral vascular, hepatic, and gastrointestinal systems. Although gastrointestinal involvement and hepatic involvement are common in HF and are associated with increased morbidity and mortality, their bidirectional association with HF progression remains poorly fathomed. The current understanding of multiple mechanisms, including proinflammatory cytokine milieu, hormonal imbalance, and anabolic/ catabolic imbalance, has been used to explain the relationship between the gut and HF and has been the basis for many novel therapeutic strategies. However, the failure of these novel therapies such as anti-tumor necrosis factor-α has resulted in further complexity. Key Words: gastrointestinal tract ◼ heart failure H eart failure (HF) is a systemic disorder caused by the inability of the heart to accommodate the venous return and to maintain sufficient cardiac output to meet the body's metabolic needs.1 These hemodynamic perturbations result in a state of systemic inflammation with well-described and well-studied consequences in a variety of other organ systems, including the renal, cerebral, musculoskeletal, and immune systems. In contrast, the gastrointestinal and hepatic systems have received less attention, although gastrointestinal symptoms are common. With increasing clinical efforts to resuscitate the advanced HF patient, a greater appreciation and a better understanding of the gastrointestinal and hepatic manifestations of HF are needed. 2,3With some notable exceptions, gastrointestinal and hepatic involvement in heart disease has historically received little attention from cardiologists. 4 Mechanisms of gastrointestinal and hepatic dysfunction remain poorly understood despite the common presence of gastrointestinal-related symptoms and the increased morbidity and mortality associated with their presence. The specific involvement of the gastrointestinal system in HF results in a bidirectional relationship that has been called the cardiointestinal syndrome.5 For example, the systemic volume overload characteristic of HF is generally accompanied by concomitant gut edema, which can lead to bacterial translocation into the systemic circulation. Consequent monocyte activation and excessive cytokine release result in systemic inflammation, increased symptoms, and disease progression. In this review, we describe the current state of understanding of the gastrointestinal and hepatic systems in HF. Although nutritional status is also relevant in this discussion, we refer the reader to other excellent reviews of nutritional aspects of chronic disease. 7,8The Gut in HF Gastrointestinal System as a Venous ReservoirStudies of implantable hemodynamic monitors to manage HF patients document that acute decompensated HF was not associ...

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“…In early reports, CABG in ESLD patients was associated with 30% to 40% mortality and significant morbidity in 70% to 100%. 291,292 A more recent report of 18 patients with Child class A (nϭ13), B (nϭ4), and C (nϭ1) cirrhosis undergoing CABG suggested better inhospital survival of 94% and a major complication frequency of 39% in patients with Child class A and 80% in patients with Child class B/C cirrhosis. A case series of 27 CABG surgeries in patients with cirrhosis reported 26% operative mortality (Child class A, 11%; B, 18%; C, 67%).…”

Section: Evaluation For Cad In Liver Transplantation Candidatesmentioning

confidence: 99%