[HSF] Operating on Liver Cirrhotics

[A]

One of the dreaded complications is bleeding that can be so difficult to
manage. Over the years I have operated on a handful of such cases and they
have done well. I give these patients three doses of IV vitamin K1 given by
an MD over a period of ten minutes by the clock. The protocol takes three
days to complete. This is beside taking meticulous care when opening and
closing etc and the routine preop care.
I hope that this helps.

Ahmed
-----Original Message-----
From: openheart-l-bounces at lists.hsforum.com
[mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of prasannasimha
Sent: Saturday, June 30, 2007 8:28 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Operating on Liver Cirrhotics

Ani vasodilator perfusion is more based on theoretical construct of 
decreased hepatic flow with CPB. It is like TRT its use has to be 
ultimately be proved.It has been shown that nitrate infusions increases 
hepatic flow during CPB. Delivering targetted would be better hopefully.
Prasanna
Ani Anyanwu wrote:
> I would be keen to know approaches members use to reduce the morbidity or
mortality associated with cardiac surgery in patients with liver cirrhosis.

> We have an active liver transplant program and few times a year i have to
operate on patients requiring liver transplant who have co-existing cardiac
problems. These patients seem so unpredictable and mortality has been high
such that on occasion some surgeons have done the (cardiac) procedure in
combination with the liver transplant.
> I would be grateful for any tips on dealing with this difficult group.
Prassana I know has a regime of hepatic infusion of venodilators - is their
logic or data to back this and do others have experience of this technique?
Do people give Factor VII pre-emptively?
> Thanks
> Ani
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