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Long-Term Cardiac Morbidity and Mortality in Patients With Aortic Valve Disease Following Liver Transplantation: A
Ramona Nicolau-Raducu1, Thomas Marshall2, Hamang Patel3
11 Department of Anesthesiology, Ochsner Medical Center, New Orleans, LA, USA.
Insights
Patients with aortic valve disease undergoing liver transplant had higher rates of coronary intervention post-surgery. However, overall survival and other cardiac complications were similar compared to those without aortic valve disease.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Aortic valve (AV) disease is a concern in patients undergoing orthotopic liver transplantation (OLT).
- Assessing postoperative cardiac outcomes in OLT patients with AV disease is crucial.
Purpose of the Study:
- To evaluate the incidence of cardiac morbidity and mortality in OLT patients with pre-existing AV disease.
- To compare outcomes between OLT patients with AV disease and a matched control group without AV disease.
Main Methods:
- Retrospective study comparing OLT patients with AV disease (n=53) to a matched control group (n=212).
- Matching criteria included: transplant type, age, gender, race, BMI, MELD score, redo-transplant status, renal replacement therapy, NASH, viral hepatitis, diabetes, and CAD.
- AV group included patients with aortic stenosis (AS), aortic regurgitation, or prior AV replacement.
Main Results:
- No significant difference in overall survival or major post-transplant cardiac complications (ACS, HF, dysrhythmia) between groups.
- Higher incidence of coronary intervention post-OLT in the AV group (11%) compared to the control group (3%).
- 9% of the AV group required intervention for AV disease post-OLT, with none in the control group.
Conclusions:
- Patients with pre-existing AV disease or replacement undergoing OLT face increased risks.
- Cardiac complications such as myocardial infarction, need for AV replacement, or cardiac death are significant within 1-3 years post-OLT.
- While overall survival is similar, specific cardiac interventions are more frequent in the AV disease cohort.
Introduction:
This retrospective study examined the role of aortic valve (AV) disease in patients who underwent orthotopic liver transplantation (OLT) to determine the incidence of postoperative cardiac morbidity and mortality when compared with a matched control group without AV disease.
Methods:
Patients were included in the AV group if diagnosed with aortic stenosis (AS) or aortic regurgitation or had received AV replacement prior to OLT. The AV group (n = 53) was matched to a control group (n = 212) with the following preoperative variables: type of organ transplanted, age, gender, race, body mass index, MELD, redo-transplantation, preoperative renal replacement therapy, nonalcoholic steatohepatitis, viral hepatitis, diabetes, and coronary artery disease. A 1:4 ratio was utilized to improve the efficiency and power of the analysis.
Results:
No significant difference in survival or posttransplant cardiac complications (acute coronary syndrome, heart failure, or dysrhythmia) was observed between groups. However, statistically significantly more patients-11% (6/53)-required coronary intervention following OLT in the AV group, whereas 3% (7/212) required coronary intervention (χ2 = 5.8; P = .0156) in the control group. Following OLT, 9% (5/53) in the AV group required surgical or nonsurgical AV intervention, whereas no valvular events were observed in the control group. Event-free survival in the AV group, with an end point defined as AV intervention (n = 5) and death (n = 10), was 92% (49/53) at 1 year, 83% (44/53) at 3 years, and 72% (38/53) at 5 years.
Conclusions:
Patients with pretransplant AV replacement or AS have significant cardiac complications (myocardial infarction, AV replacement, or cardiac death) in 1 to 3 years post-OLT.
