Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2363-2369. doi: 10.1053/j.jvca.2020.08.051. Epub 2020 Aug 26.
Combined cardiothoracic surgery and liver transplantation (cCSLT) recently increasingly has been used. Despite that, liver transplant immediately after cardiothoracic surgery has not been well-characterized. The authors aimed to compare perioperative management and postoperative outcomes between patients undergoing cCSLT and isolated liver transplantation (iLT).
A retrospective study.
University tertiary medical center.
Twenty-five cCSLT patients and 1091 iLT patients at a single institution from 2010 to 2017.
Twenty-five cCSLT patients were compared with 100 randomly selected and 100 propensity-matched iLT patients.
All cCSLT patients underwent comprehensive preoperative evaluation by a multidisciplinary team. Of 25 cardiothoracic surgeries, heart transplant (n = 9) was most common, followed by coronary artery bypass grafting (n = 5) and lung transplant (n = 3). Intraoperative management of cCSLT was provided by 2 separate teams, one for cardiothoracic surgery and one for liver transplantation. Patients undergoing cCSLT often required cardiopulmonary bypass, an intra-aortic balloon pump, extracorporeal membrane oxygenation, or cardiac pharmacologic therapies and, additionally, needed more interventions including antifibrinolytic administration, venovenous bypass, massive blood transfusion, and platelet transfusions compared with iLT patients. Ninety-day survival rates were similar in the cCSLT (100%) and iLT groups (random iLT 87% and matched iLT 93%, log-rank test p = 0.089).
Despite having end-stage liver disease and advanced cardiothoracic disorders and experiencing a complex intraoperative course, cCSLT patients had comparable 90-day survival to iLT patients. Comprehensive planning before transplant, optimal patient/donor selection, the multiple-team model, and meticulous intraoperative management are critical to the success of cCSLT.
心脏胸外科与肝移植联合手术（cCSLT）最近越来越多地被应用。尽管如此，心脏胸外科手术后立即进行肝移植尚未得到充分描述。作者旨在比较 cCSLT 与孤立性肝移植（iLT）患者围手术期管理和术后结局。
回顾性研究。
大学三级医疗中心。
2010 年至 2017 年期间，同一机构的 25 例 cCSLT 患者和 1091 例 iLT 患者。
25 例 cCSLT 患者与 100 例随机选择和 100 例倾向匹配的 iLT 患者进行比较。
所有 cCSLT 患者均由多学科团队进行全面术前评估。25 例心脏胸外科手术中，心脏移植（n=9）最为常见，其次是冠状动脉旁路移植术（n=5）和肺移植（n=3）。cCSLT 的术中管理由 2 个独立的团队提供，一个用于心脏胸外科手术，一个用于肝移植。与 iLT 患者相比，行 cCSLT 的患者通常需要心肺转流、主动脉内球囊泵、体外膜氧合或心脏药物治疗，此外还需要更多的干预措施，包括抗纤维蛋白溶解药物的使用、静脉-静脉旁路、大量输血和血小板输注。cCSLT 组（100%）和 iLT 组（随机 iLT 组 87%和匹配 iLT 组 93%，对数秩检验 p=0.089）的 90 天生存率相似。
尽管 cCSLT 患者患有终末期肝病和晚期心脏胸外科疾病，并经历了复杂的术中过程，但他们的 90 天生存率与 iLT 患者相似。移植前的全面规划、最佳患者/供者选择、多团队模式和细致的术中管理对 cCSLT 的成功至关重要。
