The patient with severe comorbidities: Cardiac disease

In order to properly discuss the anesthetic management of patients with cardiac comorbidities undergoing liver transplantation (LTx), we will first briefly describe the cardiovascular changes that occur as a result of liver failure, including hemodynamic changes and cirrhotic cardiomyopathy. We will then concentrate on the following comorbidities: coronary artery disease (CAD), valvular heart disease, and hypertrophic obstructive cardiomyopathy (HOCM). Preoperative diagnosis of cardiac comorbidities is essential to ensure preoperative optimization and proper intraoperative management and helps in determining the potential need for combined cardiac surgery and LTx. Poor left ventricular function (ejection fraction <35 %) or severe cardiac disease that cannot be improved or corrected is considered to be contraindication for LTx, and only rarely can a patient with these conditions be considered for combined heart Tx/LTx [1].