Transcatheter aortic valve replacement for native aortic valve regurgitation as a bridge to liver transplantation

Abstract

Coexistence of end-stage liver disease (ESLD) and severe valvular heart disease conveyed substantial risk for patients, oftentimes leading to exclusion from liver transplantation candidacy due to inability to safely offer cardiac surgery prior to transplantation. Several approaches have been described, including performing transplantation and valve surgery concurrently, or in sequence. Both options, however, have associated complications: catastrophic repercussion of peri-operative coagulopathy and organ dysfunction post-transplantation, respectively. The introduction of transcatheter procedures offered a safer alternative for high-risk patients; however, its recognized indications remained limited. A novel approach to this surgical dilemma by performing transcatheter aortic valve replacement (TAVR) for severe native aortic valve regurgitation in a patient on the liver transplant list has been presented. The procedure proved to be an effective management for the aortic valve insufficiency, improving our patient's hemodynamics in preparation for the subsequent orthotopic liver transplantation (OLT). © 2015 Wiley Periodicals, Inc.

Transcatheter aortic valve replacement (TAVR) as bridge therapy restoring eligibility for liver transplantation in cirrhotic patients

“…[8][9][10][11] History of cirrhosis or liver disease is frequently an exclusion criterion for randomized controlled trials and only a few observations have shown so far the feasibility of TAVR as a bridge or salvage therapy for patients with end-stage liver diseases (n = 6) or before kidney transplantation (n = 1). [12][13][14][15][16] We report herein 3 additional cases of cirrhotic patients with severe AS who benefited from a TAVR procedure while awaiting LT.…”

Transcatheter aortic valve implantation in the patients with chronic liver disease

“…Several case reports or series have been published to share the successful and promising experiences of TAVI in the patients awaiting liver transplantation. [26,27] However, the case number was still very small and further investigation should be performed to validate the safety and efficacy of TAVI in this group of patients.…”

Aortic valve-sparing procedure—a durable choice in liver transplantation recipient

“…There are 2 reports in the literature on patients undergoing transcatheter procedures before LT. Coverstone et al [ 7 ] described 4 patients who underwent aortic balloon valvuloplasty for severe aortic stenosis pre-LT, while Cabasa et al [ 8 ] reported transcatheter aortic valve implantation (TAVI) in another patient with aortic regurgitation listed for LT (Table 1 ). To the best of our knowledge, our patient is the first to undergo an open surgical procedure involving the ascending aorta and the aortic valve prior to LT. We also considered various possible alternative procedures, all of which were discarded.…”