**1. Introduction**

Liver transplantation is the only treatment for end-stage liver disease regardless of its aetiology as well as for other categories of liver failure. The procedure is performed on a high-risk patient with impairment of cardiovascular, pulmonary, renal and coagulation systems. Due to increasingly good results, transplant candidates are older and frequently have co-morbidities.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Since the first transplant interventions in the 1960s, postintervention morbidity rate decreased and patient survival increased. This is due to the improvement of surgical technique and anaesthetic management as well as the emergence of new generations of immunosuppressants. Medical care of pre-transplant patients has also experienced a favourable evolution.

• diastolic dysfunction; it is more pronounced in patients with ascites,

abstinence from alcohol can significantly improve the symptoms.

increased risk of ventricular arrhythmias [7].

*2.1.3. Other causes for cardiac impairment*

restrictive cardiomyopathy [2].

*2.1.4. Steps of cardiac evaluation*

echocardiography.

methods.

coronary heart disease can be underestimated.

The echocardiography evaluates the following [8]:

• measurements of cardiac chambers • valvular characteristics and function

nounced in patients with ascites [6]

diac complications.

• electrophysiological alterations like prolongation of the QT interval [3, 6].

The prolonged QT interval is associated with the severity of liver disease and the degree of portal hypertension as well as mortality [2]. A QTc interval of >440 ms correlates with an

Anesthesia for Liver Transplantation http://dx.doi.org/10.5772/intechopen.75167 211

Both diastolic and systolic dysfunction can be causes of postoperative pulmonary oedema. Right heart dysfunction, when present, has a higher predictive value for postoperative car-

Chronic consumption of ethanol may cause dilated cardiomyopathy; it is characterized by left ventricular dilatation with altered systolic function. In the initial stages of heart disease,

In the case of haemochromatosis, excess iron will be deposited in the myocardium, leading to

Investigating a patient will begin with the existence of a history of heart disease as well as symptoms suggestive of cardiovascular events such as rhythm disorders or angina. Because of their low exercise capacity due to cirrhosis, the incidence of angina is low and frequently

The baseline assessment includes an electrocardiographic (ECG) recording at rest and an

• evaluation of systolic function of the left ventricle (LV) expressed as ejection fraction; we must not forget that these values are obtained under the conditions of low blood pressure due to the vasodilatation of the cirrhotic patient, so they can underestimate the real ejection fraction • evaluation of diastolic function of the left ventricle by measuring early and late diastolic velocities through the mitral valve to determine the E/A ratio (ventricular filling phases = initial E vs. tardive A); E/A < 1 reflects a diastolic dysfunction; diastolic dysfunction is more pro-

If electrocardiogram and echocardiography are two mandatory pre-transplant investigations, the question is what other methods should be used in those patients who require additional

According to AASLD (American Association for the Study of Liver Disease), AHA (American Heart Association) and ACCF (American College of Cardiology Foundation), additional

The outcome of patients undergoing liver transplantation depends on the perioperative management. Dedicated and specialized teams for liver transplantation have a major role on the outcome of these patients.
