Department of Cardiothoracic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, Florida, 32224, USA.
Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Gen Thorac Cardiovasc Surg. 2022 Aug;70(8):714-720. doi: 10.1007/s11748-022-01783-w. Epub 2022 Feb 10.
Morbidity and mortality rates associated with liver transplant are high for patients with concomitant heart disease. Traditionally, such cases were considered contraindications for transplant. The objective of our study was to assess the outcome of combined surgical approaches.
A prospectively maintained database was analyzed of patients undergoing cardiac surgery and liver transplant at our institution. Twelve identified patients underwent combined cardiac operation and liver transplant. A control group was created (n = 24) with the same selection criteria.
Median patient age was 64.94 years in the combined group vs 63.80 in the control, and in both groups, 58% were male. Left ventricular ejection fraction (0.60), body mass index (30.1), and median (range) score of the Model for End-stage Liver Disease (18 [9-33]) were the same in both groups. The cardiac operations combined with liver transplant were coronary artery bypass grafting, valve replacement procedures, and ascending thoracic aortic aneurysm repair. Piggyback liver transplant was performed for all patients. Survival periods of 1, 5, and 10 years for control vs combined cases were 90 vs 62%, 79 vs 55%, and 70 vs 45%, respectively (P = 0.03).
Concomitant cardiac procedure and liver transplant is a valid treatment option and should be considered with risk stratification criteria of the patient with end-stage liver disease and cardiac surgical pathologic characteristics.
患有合并心脏病的患者进行肝移植的发病率和死亡率很高。传统上，此类病例被认为是移植的禁忌症。本研究的目的是评估联合手术方法的结果。
分析了我院行心脏手术和肝移植的患者的前瞻性维护数据库。 12 名患者接受了联合心脏手术和肝移植。创建了一个对照组（n=24），具有相同的选择标准。
联合组患者的中位年龄为 64.94 岁，对照组为 63.80 岁，两组中 58%为男性。左心室射血分数（0.60）、体重指数（30.1）和终末期肝病模型评分中位数（范围）（18 [9-33]）在两组中相同。联合进行的心脏手术包括冠状动脉旁路移植术、瓣膜置换术和升主动脉瘤修复术。所有患者均进行背驮式肝移植。对照组和联合组的 1、5 和 10 年生存率分别为 90%比 62%、79%比 55%和 70%比 45%（P=0.03）。
合并心脏手术和肝移植是一种有效的治疗选择，应根据终末期肝病患者的风险分层标准和心脏手术病理特征进行考虑。
