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Published on: August 17, 2022
Combined cardiac surgery procedures and liver transplant: a single-center experience
Samuel Jacob1, Justin H Nguyen2, Magdy M El-Sayed Ahmed3
1Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA. Jacob.Samuel@mayo.edu.
Insights
Combined heart surgery and liver transplant is a viable option for patients with both conditions, offering improved survival outcomes when carefully selected. This approach addresses previously considered contraindications for liver transplantation.
Area of Science:
- Cardiology
- Hepatology
- Transplant Surgery
Background:
- Patients with liver disease often have co-existing heart conditions, historically leading to exclusion from liver transplant.
- High morbidity and mortality rates are associated with liver transplant in patients with heart disease.
Purpose of the Study:
- To evaluate the outcomes of combined surgical procedures for liver transplant in patients with concomitant heart disease.
- To determine if combined cardiac surgery and liver transplant is a safe and effective treatment option.
Main Methods:
- Analysis of a prospectively maintained database of patients undergoing cardiac surgery and liver transplant.
- Comparison of a combined group (n=12) with a control group (n=24) with similar selection criteria.
- Inclusion of various cardiac procedures such as coronary artery bypass grafting, valve replacement, and aortic aneurysm repair.
Main Results:
- No significant differences in age, sex, ejection fraction, BMI, or Model for End-stage Liver Disease score between groups.
- Lower survival rates observed in the combined group at 1, 5, and 10 years (62%, 55%, 45%) compared to the control group (90%, 79%, 70%).
- Statistical significance noted in survival outcomes (P=0.03).
Conclusions:
- Combined cardiac procedures and liver transplant represent a valid therapeutic strategy.
- Careful patient selection and risk stratification are crucial for successful outcomes.
- This approach should be considered for patients with end-stage liver disease and cardiac pathology.
Objective:
Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches.
Methods:
A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria.
Results:
Median patient age was 64.94 years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9-33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10 years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03).
Conclusion:
Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics.
