Dunton R F, Karlson K J, Leonardi H K, Jenkins R L, Berger R L
Division of Cardiothoracic Surgery, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 1994 Oct;58(4):1054-8. doi: 10.1016/0003-4975(94)90453-7.
Coronary artery bypass grafting was performed on 3 patients for refractory angina pectoris 48, 5, and 40 months after orthotopic liver transplantation. At the time of the cardiac operation, all 3 patients had drug-induced moderate renal dysfunction, and 1 of the 3 exhibited mild chronic rejection of the graft. Maintenance immunosuppressive therapy was continued during the cardiac operation and the perioperative period. Stress-dose steroids and standard prophylactic antibiotics were also employed. All 3 patients tolerated the cardiac surgical procedure without hepatic decompensation, excessive bleeding, infection, impaired wound healing, and other complications related to the transplanted organ or to the immunosuppressive therapy. Early postoperative liver function test results showed mild transient deterioration. One patient experienced a brief psychotic episode and massive upper gastrointestinal bleeding. Both complications were attributed to the steroids used in immunosuppressive therapy. Follow-up ranging from 2 to 24 months after coronary artery bypass grafting revealed that the patients were active and had no cardiac symptoms or manifestations of hepatic decompensation. It appears from this limited experience that cardiac operations can be performed safely in patients who have previously undergone liver transplantation.
3例患者在原位肝移植术后48个月、5个月和40个月因顽固性心绞痛接受了冠状动脉旁路移植术。在心脏手术时，所有3例患者均有药物性中度肾功能不全，其中1例出现轻度移植物慢性排斥反应。心脏手术期间及围手术期继续维持免疫抑制治疗。还使用了应激剂量的类固醇和标准预防性抗生素。所有3例患者均耐受心脏外科手术，未出现肝失代偿、出血过多、感染、伤口愈合受损以及与移植器官或免疫抑制治疗相关的其他并发症。术后早期肝功能检查结果显示有轻度短暂恶化。1例患者出现短暂的精神错乱发作和大量上消化道出血。这两种并发症均归因于免疫抑制治疗中使用的类固醇。冠状动脉旁路移植术后2至24个月的随访显示，患者活动自如，无心脏症状或肝失代偿表现。从这一有限的经验来看，先前接受过肝移植的患者可以安全地进行心脏手术。
