NYMC Faculty Publications

Anesthetic Management of Combined Heart-Liver Transplantation in a Patient with Ischemic Cardiomyopathy and Cardiac Cirrhosis: Lessons Learned

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Journal of Cardiothoracic and Vascular Anesthesia

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Second Department



COMBINED HEART-LIVER transplantation (CHLT) in carefully selected patients has resulted in acceptable outcomes since its introduction by Starzl in 1984.1 The procedure, however, remains relatively uncommon, with 188 cases performed in the United States to date.2 CHLT recipients range from patients with dual-organ pathology, such as amyloidosis, metabolic diseases, or alcoholism, to patients with primary end-stage liver cirrhosis associated with severe cardiomyopathy, to others with terminal right-sided heart failure (HF) resulting in liver cirrhosis. HF resulting in cardiac cirrhosis represents one of the least frequent indications for CHLT,3 in part due to ongoing advances in the treatment of heart disease; nonetheless, its true prevalence in the general population is difficult to assess as it commonly is subclinical. The latter patient population presents a unique set of pathophysiologic considerations with inherent challenges pertaining to perioperative management, as will be detailed in this case study. The patient presented has provided written consent for consultation of his medical records for the purpose of this report