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Anesthetic considerations for combined heart--liver transplantation in patients with Fontan-associated liver disease
Ryan E Hofer1, Jon M Christensen, James Y Findlay
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Managing combined heart-liver transplantation for Fontan-associated liver disease (FALD) is complex. Careful perioperative care is crucial for successful outcomes in these Fontan circulation patients.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Surgery
Background:
- Increased survival after the Fontan procedure reveals new complications like Fontan-associated liver disease (FALD).
- FALD necessitates complex management strategies, particularly for patients requiring combined heart-liver transplantation (CHLT).
Purpose of the Study:
- To review the existing literature on the perioperative management of CHLT in patients with FALD.
- To highlight the complexities and current understanding of managing FALD patients undergoing CHLT.
Main Methods:
- Literature review of perioperative management strategies for CHLT in FALD.
- Analysis of patient risks including hemodynamic instability, blood loss, and coagulopathies.
Main Results:
- CHLT for FALD is complex, involving risks like hemodynamic disturbances and coagulopathies.
- Maintaining adequate transpulmonary pressure gradients is critical for surgical success.
- Multidisciplinary postoperative care is essential.
- Limited data suggests good outcomes with CHLT in select FALD cases.
Conclusions:
- Perioperative management of CHLT in FALD is challenging due to limited literature.
- Further research is required to establish optimal perioperative protocols for FALD patients undergoing CHLT.
Purpose Of Review:
The success of the Fontan procedure has led to increased survival of patients born with certain congenital heart disease to the point that new sequlae, as a result of Fontan circulation, are being discovered. Included among these is Fontan-associated liver disease (FALD). The purpose of this review is to present available literature on the perioperative management of the combined heart--liver transplantation (CHLT) in patients with FALD.
Recent Findings:
The perioperative management of a combined heart-liver transplant in a patient with Fontan circulation is complex. The patient is at risk for hemodynamic disturbances, significant blood loss, coagulopathies, and metabolic derangements. The maintenance of an appropriate transpulmonary pressure gradient is paramount to success. Postoperative management should be accomplished by a multidisciplinary care team. Limited series have demonstrated good outcomes in patients who have undergone CHLT.
Summary:
The perioperative management of CHLT in patients with FALD is complex and available literature is limited. Future studies are needed to further assess proper perioperative management of patients with FALD who undergo CHLT.
