VA-ECMO Cardiac Support During Liver Transplant: A Case Report

Area of Science:

• Cardiology
• Hepatology
• Cardiovascular Surgery

Background:

• Liver transplantation (LT) is often contraindicated in patients with severe cardiomyopathy due to high surgical risks.
• Extracorporeal membrane oxygenation (ECMO) is a vital rescue therapy for cardiovascular collapse.
• Severe heart disease and liver cirrhosis can create a complex clinical scenario, posing a
• Catch-22
• situation for treatment.

Observation:

• A patient with severe pulmonary hypertension, mitral valve steno-insufficiency, and right heart dysfunction required LT.
• The patient's severe heart disease contraindicated LT, while liver cirrhosis precluded necessary mitral valve surgery.
• Veno-arterial ECMO (VA-ECMO) was initiated pre-operatively to manage cardiac load.

Findings:

• LT was successfully performed with VA-ECMO support, maintaining hemodynamic stability throughout the procedure.
• The patient was weaned from VA-ECMO shortly after surgery.
• At 6-month follow-up, liver and kidney functions were normal, with improved cardiac function.

Implications:

• Intraoperative VA-ECMO can facilitate LT in patients with severe heart disease, previously considered inoperable.
• This approach may reduce the risk of heart failure and reperfusion syndrome during LT.
• Successful LT with VA-ECMO support can serve as a bridge to subsequent cardiac interventions, improving long-term patient outcomes.