Excellent results of cardiac surgery in patients with previous liver transplantation

Abstract

Cardiovascular diseases requiring surgical therapy in patients with prior liver transplantation are rare. Little is known about the outcome of patients with liver allograft undergoing cardiac surgery. Herein we report our experience in this patient population with an emphasis on operative outcomes and mid-term survival. Between January 1998 and December 2004, 12 patients (mean Ϯ standard deviation age 68 Ϯ 9 years, 7 [58%] male) with previous liver transplantation who underwent cardiac surgery were identified. Main outcome measures were hospital mortality, postoperative complications, allograft function, and long-term survival. There was no in-hospital mortality. Three major complications (25%) occurred, including 1 each (8%) of respiratory failure, renal failure, and biliary leakage. All complications were resolved by the time of discharge. Allograft dysfunction determined by an increase of liver function parameters was noticed in 4 (33%) and recovered before discharge. The average length of stay in intensive care unit was 72 Ϯ 45 hours, and the mean length of stay in hospital was 22 Ϯ 17 days. One-and 5-year survival was 91% Ϯ 8% and 67% Ϯ 14%, respectively. Cardiac surgery can be performed safely in liver transplant recipients with extremely low mortality and acceptable morbidities. Allograft dysfunction is a common finding, but it is transient, with early functional recovery. Five-year survival of liver recipients undergoing cardiac procedures is similar to that of the general population undergoing cardiac surgery. Our data suggest that these patients should be considered for cardiac surgery in reference centers with expertise in complex cardiac procedures and perioperative management of these highly specific patients. Liver Transpl 13:1317Transpl 13: -1323Transpl 13: , 2007

Outcomes of Patients Who Undergo Cardiac Surgical Procedures After Liver Transplantation

“…The 1-, 5-, and 10-year overall survival rates were 90%, 51%, and 35%, respectively. These rates are comparable to those reported in the literature (1-year rates, 77% to 91%, and 5-year rates, 67% to 69%, respectively) [22]. The 5year survival rates are comparable to reported survival rates in patients undergoing cardiac surgical procedures without a history of solid organ transplantation.…”

Coronary artery disease in orthotopic liver transplantation: Pretransplant assessment and management

“…With respect to the timing of revascularization in the OLT population, preoperative revascularization is commonly advocated in order to minimize any subsequent liver transplantation risks. Surgical revascularization prior to OLT has been reported in small case cohorts, but it is associated with significant postoperative mortality (approximately 17%‐30%) and morbidity (25%‐58%) in comparison with patients without cirrhosis (mortality = 1.8%, morbidity = 8.4%); this has been correlated with the degree of hepatic dysfunction 68, 74‐77…”

Cardiac Surgery Outcomes in Abdominal Solid Organ Transplant Recipients

“…This rate is comparable to rates shown by others [12,14,24], who reported a mortality rate ranging from 0% to 7%. Several smaller series have reported mortality rates as low as zero after cardiac operations in hepatic transplant recipients [2,12,25]. The 30-day observed mortality in the transplant group of 4% was exactly that predicted by The Society of Thoracic Surgeons (STS) Database risk of mortality model (observed/ expected ratio of 1).…”