Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Avenue West, Montreal, Quebec, Canada.
Can J Anaesth. 2010 Apr;57(4):355-60. doi: 10.1007/s12630-010-9263-y. Epub 2010 Jan 27.
Combined heart and liver transplant is a rare procedure to treat end-stage cardiac and liver disease. First performed during cardiopulmonary bypass and anticoagulation, subsequent concerns about increased bleeding changed the strategy to performing liver implantation following separation from cardiopulmonary bypass. Considering the overall decrease in transfusion requirements during liver transplant and the potential benefits to the transplanted heart to remain on cardiopulmonary bypass during liver implantation, we revised the strategy for combined heart and liver transplant. We report the clinical course of four consecutive patients who underwent this procedure in our institution.
Patient 1 was a 53-yr-old male with familial hypertrophic cardiomyopathy and congestive cirrhosis. Patient 2 was a 57-yr-old male with hypertrophic restrictive cardiomyopathy and congestive cirrhosis. Patient 3 was a 48-yr-old male with dilated cardiomyopathy and hepatitis B cirrhosis. Patient 4 was a 57-yr-old male with ischemic cardiomyopathy and congestive cirrhosis. Each patient underwent combined heart and liver transplant, with liver implantation performed during cardiopulmonary bypass and anticoagulation. Estimated blood loss ranged from 1,000 to 3,000 mL. Intraoperative transfusion included 2-5 U of packed red blood cells, 4-12 U of fresh frozen plasma, 0-20 U of cryoprecipitate, and 5-23 U of platelets. All patients remain well 25-38 months after surgery.
Combined heart and liver transplant during cardiopulmonary bypass is a viable strategy that may confer benefit to this unique type of patient.
心脏和肝脏联合移植是一种治疗终末期心脏和肝脏疾病的罕见手术。该手术最初在心肺旁路和抗凝过程中进行，随后由于担心出血增加，手术策略改为在心肺旁路分离后进行肝脏移植。考虑到肝脏移植过程中整体输血需求减少，以及移植心脏在肝脏植入过程中保持在心肺旁路的潜在益处，我们修改了心脏和肝脏联合移植的策略。我们报告了在我们机构中连续进行该手术的四例患者的临床经过。
患者 1 为 53 岁男性，患有家族性肥厚型心肌病和充血性肝硬化。患者 2 为 57 岁男性，患有肥厚性限制型心肌病和充血性肝硬化。患者 3 为 48 岁男性，患有扩张型心肌病和乙型肝炎肝硬化。患者 4 为 57 岁男性，患有缺血性心肌病和充血性肝硬化。每位患者均接受了心脏和肝脏联合移植，在心肺旁路和抗凝过程中进行了肝脏移植。估计失血量从 1000 到 3000 毫升不等。术中输血包括 2-5 单位的浓缩红细胞、4-12 单位的新鲜冷冻血浆、0-20 单位的冷沉淀和 5-23 单位的血小板。所有患者在手术后 25-38 个月后仍然状况良好。
在心肺旁路过程中进行心脏和肝脏联合移植是一种可行的策略，可能对这种特殊类型的患者有益。
