Aortic valve replacement in a patient with liver cirrhosis and coagulopathy

Open heart surgery in patients with end-stage liver disease is accompanied by various complications. Coagulopathy resulting from liver failure tends to cause uncontrollable hemorrhage. Severe aortic insufficiency has moderate to severe risk for liver transplantation. It can lead to heart failure, liver congestion, and finally rejection of the transplanted liver. Aortic valve replacement in patients diagnosed as having cirrhosis has a significant risk of mortality because of the above-mentioned complications. We present a patient with liver cirrhosis and severe aortic insufficiency who had thrombocytopenia and severe coagulopathy. Aortic valve replacement was performed successfully using cardiopulmonary bypass before the liver transplantation. Hemostasis management was done effectively perioperation. The postoperative course was uneventful, and the patient was discharged after 10 days. Liver transplantation was performed successfully 2 months later.