Strategy and Outcomes of Cardiac Surgery in Patients With Cirrhosis: Comprehensive Approach With Liver Transplant...

Area of Science:

• Cardiology
• Hepatology
• Transplant Surgery

Background:

• Cardiac surgery is often contraindicated in advanced liver cirrhosis (LC) due to high risks.
• Limited data exists on managing cardiac surgery in LC patients.
• This study presents a novel strategy and evaluates outcomes for this population.

Purpose of the Study:

• To present a treatment strategy for cardiac surgery in patients with advanced liver cirrhosis.
• To evaluate the clinical outcomes of this patient cohort.
• To assess the feasibility and survival rates of cardiac surgery in LC patients.

Main Methods:

• A strategy involving listing patients for liver transplant (LT) concurrently with cardiac surgery.
• Maintaining high cardiopulmonary bypass (CPB) flow, indexed up to 3.0 L/min/m².
• Proceeding to LT if liver function deteriorates post-cardiac surgery, indicated by rising MELD-Na scores.
• Retrospective analysis of 13 LC patients undergoing cardiac surgery between 2017 and 2024.

Main Results:

• Six patients were listed for LT; indications included coronary artery disease, endocarditis, and valve disease.
• Procedures involved coronary artery bypass grafting, valve surgery, and septal myectomy.
• Postoperative complications included pleural effusion, bleeding, and acute kidney injury; no in-hospital deaths occurred.
• Five patients underwent LT post-cardiac surgery, with 1- and 3-year survival rates of 100% and 75.0%, respectively.

Conclusions:

• Cardiac surgery in advanced liver cirrhosis patients is feasible using a strategy of high CPB flow and LT backup.
• This approach offers acceptable early and midterm survival.
• Successful implementation requires an experienced cardiac surgery and LT program.