Strategy and Outcomes of Cardiac Surgery in Patients With Cirrhosis: Comprehensive Approach With Liver Transplant Program

Authors

• Junichi Shimamura, New York Medical College
• Kenji Okumura, New York Medical College
• Ryosuke Misawa, New York Medical College
• Roxana Bodin
• Seigo Nishida, New York Medical College
• Sooyun Tavolacci
• Ramin Malekan, New York Medical CollegeFollow
• Steven Lansman, New York Medical CollegeFollow
• David Spielvogel, New York Medical CollegeFollow
• Suguru Ohira, New York Medical CollegeFollow

Author Type(s)

Faculty

DOI

10.1111/ctr.15451

Journal Title

Clinical Transplantation

First Page

15451

Last Page

15451

Document Type

Article

Publication Date

9-2024

Department

Surgery

Keywords

Humans, Male, Female, Liver Transplantation, Middle Aged, Liver Cirrhosis, Retrospective Studies, Cardiac Surgical Procedures, Prognosis, Aged, Postoperative Complications, Survival Rate, Follow-Up Studies, COVID-19, Treatment Outcome, Heart Diseases

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Cardiac surgery is considered a contraindication in patients with advanced liver cirrhosis (LC) due to increased mortality and morbidity. There are limited data on the treatment strategy and management of this population. We aimed to present our strategy and evaluate the clinical outcome of cardiac surgery in patients with LC.

METHODS: Our strategy was (i) to list patients for liver transplant (LT) at the time of cardiac surgery; (ii) to maintain high cardiopulmonary bypass (CPB) flow (index up to 3.0 L/min/m

RESULTS: Six patients were listed for LT. Indications for cardiac surgery included coronary artery disease (N = 7), endocarditis (N = 2), and tricuspid regurgitation (N = 1), tricuspid stenosis (N = 1), mitral regurgitation (N = 1), and hypertrophic obstructive cardiomyopathy (N = 1). The Child-Pugh score was A in five, B in six, and C in one patient. The procedure included coronary artery bypass grafting (N = 6), single valve surgery (mitral valve [N = 2] and tricuspid valve [N = 1]), concomitant aortic and tricuspid valve surgery (N = 2), and septal myectomy (N = 1). Two patients had a history of previous sternotomy. The perfusion index during CPB was 3.1 ± 0.5 L/min/m

CONCLUSION: Cardiac surgery maintaining high CPB flow with LT backup is a feasible strategy in an otherwise inoperable patient population with an acceptable early and midterm survival when performed in a center with an experienced cardiac surgery and LT program.

Recommended Citation

Shimamura, J., Okumura, K., Misawa, R., Bodin, R., Nishida, S., Tavolacci, S., Malekan, R., Lansman, S., Spielvogel, D., & Ohira, S. (2024). Strategy and Outcomes of Cardiac Surgery in Patients With Cirrhosis: Comprehensive Approach With Liver Transplant Program. Clinical Transplantation, 38 (9), 15451-15451. https://doi.org/10.1111/ctr.15451