<scp>TAVR</scp> versus <scp>SAVR</scp> in patients with severe aortic stenosis and concomitant end stage liver disease: When less is more

Tarantini, Giuseppe; Fovino, Luca Nai

doi:10.1002/ccd.29291

Cited by 2 publications

(1 citation statement)

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“…LT may cause changes in circulating volume due to massive blood loss [ 2 ], needed for transfusion [ 3 ], haemodynamic instability and haemodynamic instability secondary to the ischaemia–reperfusion syndrome [ 4 ]. Patients with left ventricular dysfunction, related to cirrhosis (cirrhotic cardiomyopathy) [ 5 ] or with clinically relevant valvulopathies [ 6 ] or history of coronary artery disease (CAD) have an increased risk of morbidity and mortality both in the peri- and post-operative phases of LT [ 7 ]. Pre-existent CAD worsens the early surgical outcome [ 8 ] and raises mortality after LT [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Induced myocardial ischemia in candidates to liver transplantation without evidence of heart disease

Mircoli,

Bacà,

Antonelli

et al. 2023

Annals of Medicine

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Background Coronary artery disease (CAD) is associated with perioperative liver transplantation (LT) mortality. In absence of a defined risk algorithm, we aimed to test whether stress echocardiography and coronary computed tomography angiography (CCTA) could detect CAD in end-stage liver disease (ESLD) patients without previous evidence of heart disease. Methods LT candidates ≥30 years underwent a cardiovascular (CV) assessment through stress echocardiography. CCTA was performed in patients ≥50 years with two or more CV risk factors (e.g. diabetes, CAD family history, dyslipidaemia). Coronary angiography (CAG) was scheduled when stress echocardiography and/or CCTA were positive. Sensibility, specificity, positive and negative predictive values of stress echocardiography and CCTA were assessed by numbers of coronary revascularization (true positives) and lack of acute coronary events over a mean follow-up of 3 years (true negatives). Results Stress echocardiography was performed in 273 patients, CCTA in 34 and CAG in 41. Eight patients had critical coronary lesions, and 19 not-critical lesions. Sensitivity, specificity, positive and negative predictive values were 50.0%, 90.2%, 13.3% and 98.4% for stress echocardiography and 100%, 76.7%, 36.4% and 100% for CCTA. Among 163 patients who underwent LT (57.6%), 16 died and 5 had major adverse CV events over a mean follow-up of 3 years. Conclusions A very low prevalence of CAD in a selected population of ESLD at intermediate to high CV risk was found. A screening based on stress echocardiography and CCTA resulted in low incidence of post-LT acute coronary events in ELSD patients. CAD has no impact on mid-term survival.

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