Coverstone Edward, Korenblat Kevin, Crippin Jeffrey S, Chapman William C, Kates Andrew M, Zajarias Alan
Cardiovascular Division, Washington University School of Medicine, Campus Box 8086, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
Gastroenterology Division, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
Case Rep Cardiol. 2014;2014:325136. doi: 10.1155/2014/325136. Epub 2014 Nov 9.
The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.
严重主动脉瓣狭窄与终末期肝病并存会增加主动脉瓣置换手术或原位肝移植的发病率和死亡率，导致手术风险过高。我们提出在原位肝移植前采用分期球囊主动脉瓣成形术作为确定性主动脉瓣置换的桥梁。2010年至2012年期间，4例严重主动脉瓣狭窄合并终末期肝病的患者接受了分期球囊主动脉瓣成形术，随后进行了原位肝移植。由于合并症，所有患者均被认为不适合进行肝移植或主动脉瓣手术。1例患者死于瓣周脓肿并发症。3例患者成功进行了移植植入，肝功能和手术恢复良好。3例患者中有2例进行了确定性主动脉瓣置换手术，其余1例目前正在接受评估。在这个病例系列中，我们展示了一种在肝移植前进行球囊主动脉瓣成形术的新方法，作为终末期肝病患者严重主动脉瓣狭窄确定性治疗的潜在桥梁。
