Preoperative cardiac assessment in liver transplant candidates

Publication date: Available online 18 February 2020Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Andrea De Gasperi, Gregorio Spagnolin, Martina Ornaghi, Laura Petrò, Gianni BiancofioreAbstractNew and extended indications, older age, higher cardiovascular risk, and the long-standing cirrhosis - associated complications mandate specific skills for an appropriate preoperative assessment of the LT candidate. The incidence of cardiac diseases (dysrhythmias, cardiomyopathies, coronary artery disease, valvular heart disease) are increasing among LT recipients: however, no consensus exists among clinical practice guidelines for cardiovascular screening and risk stratification. In spite of different “transplant center-centered protocols”, basic “pillars” are common (electrocardiography, baseline echocardiography, functional assessment). Due to intrinsic limitations, yields and relevance of noninvasive stress tests, under constant scrutiny even if used, are discussed, focusing the definition of the “high risk” candidate and exploring noninvasive imaging and new forms of stress imaging. The aim is to find an appropriate and rational stepwise algorithm. The final commitment is to select the right candidate for a finite resource, the graft, able to save (and change) lives.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research