Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting

Abstract

Advanced coronary artery disease (CAD) is increasingly common in patients awaiting orthotopic liver transplantation (OLT). Unfortunately, in patients whose coronary artery anatomy is not amenable to angioplasty, coronary artery bypass grafting (CABG) alone may precipitate hepatic decompensation. Thus, combined liver transplant and coronary artery bypass grafting (CABG-OLT) may be required to effectively treat both conditions. Clinical records were analyzed for 5 CABG-OLT procedures at a single institution. Operative indications, technical details, and postoperative course were determined for each patient. Patients undergoing CABG-OLT had a mean age of 57.8 years (range, 54-66) and were predominantly male (80%). All patients had significant 3-vessel coronary atherosclerotic disease with preserved left ventricular function. There were no intraoperative deaths. At mean 25 months of follow-up (range, 8.0-25) there was an 80% graft and patient survival. Overall average length of stay was 21 days (range, 7-59 days). In conclusion, CABG-OLT procedure appears to be safe and effective in the population of patients with advanced CAD and liver disease. In this series, patients appear to benefit from multidisciplinary preoperative evaluation, coordination between cardiac and transplant surgeons, careful graft selection, and use of sapheno-atrial veno-veno bypass.

Combined heart and liver transplantation on cardiopulmonary bypass: report of four cases

“…17,18 While there can be no doubt that improved surgical and anesthetic techniques contribute to decreased blood transfusion requirements, 14 the use of high doses of aprotinin, as administered in our patients, mandates specific comment.…”

Consecutive coronary artery bypass grafting and orthotopic living donor liver transplantation

“…Combined CABG and OLT has emerged as a solution for this trouble. [5,6] Axelrod et al [2] reported five patients undergoing combined CABG-OLT operations. One-year survival was 80% with no perioperative death.…”

“…However, this accompanies risk for hepatic deterioration after cardiopulmonary bypass (CPB). [2] In this manner, combined CABG and OLT were performed to treat both diseases. [3] Therefore, in this article, we report consecutive CABG and OLT operations in less than 24 hours as an alternative approach.…”

Combined coronary artery bypass grafting and phaeochromocytoma excision

“…Other noncardiac procedures such as mastectomy [28,29], thymectomy [30], thyroid surgery [31], nephrectomy [32,33], renal [34] and liver transplantation [35,36], and other vascular surgeries [37,38] have also been performed. In general terms, the preference for either a staged or combined procedure is determined by specific features of each combination.…”