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General Thoracic and Cardiovascular Surgery

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10-02-2022 | Aortic Valve Replacement | Original Article

Combined cardiac surgery procedures and liver transplant: a single-center experience

Authors: Samuel Jacob, Justin H. Nguyen, Magdy M. El-Sayed Ahmed, Ian A. Makey, Osama K. Haddad, Mathew Thomas, Basar Sareyyupoglu, Si M. Pham, Kevin P. Landolfo

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2022

Abstract

Objective

Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches.

Methods

A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria.

Results

Median patient age was 64.94 years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9–33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10 years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03).

Conclusion

Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics.

Hayashida N, Shoujima T, Teshima H, et al. Clinical outcome after cardiac operations in patients with cirrhosis. Ann Thorac Surg. 2004;77(2):500–5. https://doi.org/10.1016/j.athoracsur.2003.06.021.CrossRefPubMed

An Y, Xiao YB, Zhong QJ. Open-heart surgery in patients with liver cirrhosis. Eur J Cardiothorac Surg. 2007;31(6):1094–8. https://doi.org/10.1016/j.ejcts.2007.01.042.CrossRefPubMed

Eckhoff DE, Frenette L, Sellers MT, et al. Combined cardiac surgery and liver transplantation. Liver Transpl. 2001;7(1):60–1. https://doi.org/10.1053/jlts.2001.20776.CrossRefPubMed

DeStephano CC, Harrison BA, Mordecai M, et al. Anesthesia for combined cardiac surgery and liver transplant. J Cardiothorac Vasc Anesth. 2010;24(2):285–92. https://doi.org/10.1053/j.jvca.2009.10.014.CrossRefPubMed

Axelrod D, Koffron A, Dewolf A, et al. Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting. Liver Transpl. 2004;10(11):1386–90. https://doi.org/10.1002/lt.20244.CrossRefPubMed

Morris JJ, Hellman CL, Gawey BJ, et al. Case 3-1995 three patients requiring both coronary artery bypass surgery and orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 1995;9(3):322–32. https://doi.org/10.1016/s1053-0770(05)80330-1.CrossRefPubMed

Manas DM, Roberts DR, Heaviside DW, et al. Sequential coronary artery bypass grafting and orthotopic liver transplantation: a case report. Clin Transplant. 1996;10(3):320–2.PubMed

Llado L, Figueras J. Techniques of orthotopic liver transplantation. HPB (Oxford). 2004;6(2):69–75. https://doi.org/10.1080/13651820310020756.CrossRefPubMedCentral

Glauser FL. Systemic hemodynamic and cardiac function changes in patients undergoing orthotopic liver transplantation. Chest. 1990;98(5):1210–5. https://doi.org/10.1378/chest.98.5.1210.CrossRefPubMed

10.

Lee SS. Cardiac abnormalities in liver cirrhosis. West J Med. 1989;151(5):530–5.PubMedPubMedCentral

11.

Arroyo V, Jimenez W. Complications of cirrhosis II renal and circulatory dysfunction lights and shadows in an important clinical problem. J Hepatol. 2000;32(1 Suppl):157–70. https://doi.org/10.1016/s0168-8278(00)80423-7.CrossRefPubMed

12.

Groszmann RJ. Hyperdynamic circulation of liver disease 40 years later: pathophysiology and clinical consequences. Hepatology. 1994;20(5):1359–63.CrossRef

13.

Milani A, Zaccaria R, Bombardieri G, Gasbarrini A, Pola P. Cirrhotic cardiomyopathy. Dig Liver Dis. 2007;39(6):507–15. https://doi.org/10.1016/j.dld.2006.12.014.CrossRefPubMed

14.

Benedetti E, Massad MG, Chami Y, Wiley T, Layden TJ. Is the presence of surgically treatable coronary artery disease a contraindication to liver transplantation? Clin Transpl. 1999;13(1 Pt 1):59–61. https://doi.org/10.1034/j.1399-0012.1999.t01-1-130109.x.CrossRef

15.

Parker BM, Mayes JT, Henderson JM, Savage RM. Combined aortic valve replacement and orthotopic liver transplantation. J Cardiothorac Vasc Anesth. 2001;15(4):474–6. https://doi.org/10.1053/jcan.2001.24993.CrossRefPubMed

16.

Lima B, Nowicki ER, Miller CM, Hashimoto K, Smedira NG, Gonzalez-Stawinski GV. Outcomes of simultaneous liver transplantation and elective cardiac surgical procedures. Ann Thorac Surg. 2011;92(5):1580–4. https://doi.org/10.1016/j.athoracsur.2011.06.056.CrossRefPubMed

17.

Plotkin JS, Scott VL, Pinna A, Dobsch BP, De Wolf AM, Kang Y. Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. Liver Transpl Surg. 1996;2(6):426–30. https://doi.org/10.1002/lt.500020604.CrossRefPubMed

18.

Lebbinck H, Bouchez S, Vereecke H, Vanoverbeke H, Troisi R, Reyntjens K. Sequential off-pump coronary artery bypass and liver transplantation. Transpl Int. 2006;19(5):432–4. https://doi.org/10.1111/j.1432-2277.2006.00298.x.CrossRefPubMed

19.

Suman A, Barnes DS, Zein NN, Levinthal GN, Connor JT, Carey WD. Predicting outcome after cardiac surgery in patients with cirrhosis: a comparison of Child-Pugh and MELD scores. Clin Gastroenterol Hepatol. 2004;2(8):719–23. https://doi.org/10.1016/s1542-3565(04)00296-4.CrossRefPubMed

20.

Klemperer JD, Ko W, Krieger KH, et al. Cardiac operations in patients with cirrhosis. Ann Thorac Surg. 1998;65(1):85–7. https://doi.org/10.1016/s0003-4975(97)00931-4.CrossRefPubMed

21.

Filsoufi F, Salzberg SP, Rahmanian PB, et al. Early and late outcome of cardiac surgery in patients with liver cirrhosis. Liver Transpl. 2007;13(7):990–5. https://doi.org/10.1002/lt.21075.CrossRefPubMed

Title: Combined cardiac surgery procedures and liver transplant: a single-center experience
Authors: Samuel Jacob
Justin H. Nguyen
Magdy M. El-Sayed Ahmed
Ian A. Makey
Osama K. Haddad
Mathew Thomas
Basar Sareyyupoglu
Si M. Pham
Kevin P. Landolfo
Publication date: 10-02-2022
Publisher: Springer Nature Singapore
Keywords: Aortic Valve Replacement
Heart Surgery
Heart Surgery
Aortic Valve Replacement
Arterial Diseases
Aortic Valve Replacement
CABG
CABG
Published in: General Thoracic and Cardiovascular Surgery / Issue 8/2022
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-022-01783-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined cardiac surgery procedures and liver transplant: a single-center experience

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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