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Successful off-pump pericardiectomy and coronary artery bypass in liver cirrhosis
Augustine T M Tang1, Jacek Karski, Robert J Cusimano
1Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada. gus@tang-family.org
Insights
A novel single-stage surgery combines pericardiectomy and coronary artery bypass grafting without cardiopulmonary bypass, offering excellent outcomes for patients with liver cirrhosis.
Area of Science:
- Cardiovascular Surgery
- Hepatology
Background:
- Cardiopulmonary bypass poses risks for patients with hepatic cirrhosis.
- Pericardiectomy on a beating heart effectively treats pericardial constriction.
- Off-pump coronary artery bypass grafting is a standard option for myocardial ischemia.
Observation:
- A patient presented with both pericardial constriction and multivessel coronary artery disease, alongside coexisting liver cirrhosis.
- A combined single-stage surgical approach utilizing off-pump techniques was performed.
Findings:
- The combined off-pump procedure was successfully performed without cardiopulmonary bypass.
- The patient experienced an excellent surgical outcome, despite the high-risk profile.
Implications:
- This approach offers a viable alternative for high-risk patients with dual cardiac pathologies and liver cirrhosis.
- Off-pump strategies should be considered in complex surgical scenarios involving compromised liver function.
Abstract:
Cardiopulmonary bypass can be detrimental to patients with hepatic cirrhosis. Pericardiectomy performed on the beating heart is an effective treatment for pericardial constriction. Off-pump coronary artery bypass grafting is becoming firmly established as a surgical option for myocardial ischemia associated with multivessel disease. A single-stage operation combining both procedures without utilizing cardiopulmonary bypass has not been reported. This provided excellent surgical outcome for a patient with the dual pathology and coexisting liver cirrhosis. The off-pump approach should be considered in such a high-risk scenario.
