Approach to the patient with decompensated cirrhosis and aortic stenosis during liver transplantation evaluation

Abstract

Aortic stenosis (AS) is the most common valvular disease and is reported to be present in 2%–7% of people over the age of 65. Risk factors for aortic stenosis and NASH overlap; thus, as the population ages, there is an increased likelihood that patients undergoing liver transplantation evaluation may have severe aortic stenosis. There is a high mortality rate associated with cardiac surgeries in patients with cirrhosis. Further, there are no guidelines that assist in the decision making process for patients with cirrhosis and AS. In this review, we highlight key studies that compare transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in patients with cirrhosis. We propose an algorithm as to how to approach the patient with aortic stenosis and considerations unique to patients with cirrhosis (i.e., anticoagulation, EGD for variceal assessment; need to determine timing after TAVI before listing).

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…Duong et al reviewed clinical studies comparing transcatheter aortic valve implantation (TAVR) with surgical aortic valve replacement (SAVR) in patients with cirrhosis. 65 They identified several small studies that favored TAVR over SAVR due to avoidance of cardiopulmonary bypass, decreased morbidities, and mortality in some of the studies. They also proposed an algorithm to approach patients with AS and considerations unique to patients with cirrhosis, including anticoagulation, esophagogastroduodenoscopy for variceal assessment, and need to determine timing after TAVR before listing.…”