Liver transplantation and aortic valve replacement.

Area of Science:

• Cardiology
• Hepatology
• Surgical Innovation

Background:

• Combined heart and liver procedures are complex and infrequently reported.
• Aortic valve replacement (AVR) in cirrhotic patients carries high mortality risks due to coagulopathy and renal failure.
• Few cases document combined AVR and orthotopic liver transplantation (OLT).

Observation:

• A 40-year-old male with severe cirrhosis (Child-Pugh C, MELD 29) presented with severe aortic insufficiency (AI).
• Echocardiography confirmed AI and left ventricular enlargement, necessitating AVR.
• Cardiology recommended AVR before OLT due to the risks associated with AI in cirrhosis.

Findings:

• The patient successfully underwent metallic AVR, followed 4 months later by OLT.
• Both surgical procedures were completed without complications.
• Sequential AVR prior to OLT proved effective in this specific case.

Implications:

• Individualized patient assessment is crucial for managing combined cardiac and liver disease.
• Strategic sequencing of AVR before OLT may be a viable approach in select cirrhotic patients.
• This case expands understanding of surgical management for patients with concurrent severe aortic disease and liver cirrhosis.