Cabasa Alduz S, Eleid Mackram F, Suri Rakesh M
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
Catheter Cardiovasc Interv. 2016 Oct;88(4):665-670. doi: 10.1002/ccd.26264. Epub 2015 Oct 1.
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.
终末期肝病（ESLD）与严重瓣膜性心脏病并存给患者带来了巨大风险，常常因无法在移植前安全地进行心脏手术而导致被排除在肝移植候选名单之外。已经描述了几种方法，包括同时或按顺序进行移植和瓣膜手术。然而，这两种选择都有相关并发症：分别是围手术期凝血病的灾难性后果和移植后器官功能障碍。经导管手术的引入为高危患者提供了一种更安全的替代方法；然而，其公认的适应症仍然有限。本文介绍了一种针对肝移植名单上患有严重原发性主动脉瓣反流的患者进行经导管主动脉瓣置换术（TAVR）来解决这一手术难题的新方法。该手术被证明是治疗主动脉瓣关闭不全的有效方法，改善了我们患者的血流动力学，为随后的原位肝移植（OLT）做好了准备。© 2015威利期刊公司
