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

• Published in: General thoracic and cardiovascular surgery Vol. 70; no. 8; pp. 714 - 720
• Main Authors: Jacob, Samuel, Nguyen, Justin H., El-Sayed Ahmed, Magdy M., Makey, Ian A., Haddad, Osama K., Thomas, Mathew, Sareyyupoglu, Basar, Pham, Si M., Landolfo, Kevin P.
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.08.2022; Springer Nature B.V
• Subjects: Body mass index; Cardiac Surgery; Cardiology; Cardiovascular disease; Coronary vessels; Creatinine; Ejection fraction; Electronic health records; Heart surgery; Hepatitis C; Liver cancer; Liver cirrhosis; Liver diseases; Liver transplants; Medicine; Medicine & Public Health; Mortality; Original Article; Patients; Surgical Oncology; Thoracic Surgery; Veins & arteries; Side effects; Coronary artery disease; Risk assessment; Liver disease; Liver transplantation
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-022-01783-w

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.