LAUSR

Liver dysfunction has been identified since inception as a clinical condition that undoubtedly plays an important and detrimental role on mortality and morbidity in both general and open-heart surgery. Despite the advances and improvements in medical therapies and surgical techniques as well as in cardiopulmonary bypass management, several studies have reported significantly increased hospital mortality and morbidity after coronary and valve surgery in patients with known or unknown liver dysfunction. Indeed, reported 30-day mortality ranges between 8 and 70%, with 5–10-fold increased risk compared with the general population, while complications rates range between 20 and 100%, according to the severity of liver dysfunction. Most frequently reported complications in cirrhotic patients undergoing cardiac surgery are acute renal failure, bleeding including bleeding transfusion, infection, and respiratory complications. More specifically, reported incidence of postoperative renal insufficiency requiring dialysis in patients with liver dysfunction ranges from 15 to 53% and is probably related to splanchnic vasodilatation and blood pooling, as well as the low cardiac index frequently associated with liver dysfunction. Bleeding complications in cirrhotic patients are also related to thrombocytopenia and coagulopathy which are worsened by poor nutritional status and hypoalbuminemia, as well as esophageal and