RESUMEN
BACKGROUND: Patients with end-stage liver disease and severe aortic stenosis pose a significant perioperative management challenge during liver transplantation (OLT). This patient population is at risk for significant morbidity and mortality and is often denied transplantation. CASE SERIES: We describe the successful use of balloon aortic valvuloplasty as a bridging therapy to facilitate perioperative management during OLT with traditional open aortic valve replacement after recovery from OLT. CONCLUSIONS: Valvuloplasty should be considered as an option to reduce perioperative risk in this patient population.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Valvuloplastia con Balón/métodos , Enfermedad Hepática en Estado Terminal/cirugía , Prótesis Valvulares Cardíacas , Trasplante de Hígado , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Enfermedad Hepática en Estado Terminal/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: As the prevalence of atrial fibrillation rises with age and older patients increasingly receive transplants, the perioperative management of this common arrhythmia and its impact on outcomes in liver transplantation is of relevance. METHODS: Retrospective review of 757 recipients of liver transplantation from January 2002 through December 2011. RESULTS: Nineteen recipients (2.5%) had documented pre-transplantation atrial fibrillation. Sixteen patients underwent liver and 3 a combined liver-kidney transplantation. Three patients died within 30 days (84.2% 1-month survival) and another 3 within 1 year of transplantation (68.4% 1-year survival). Compared with patients without atrial fibrillation, the relative risk of death in the atrial fibrillation group was 5.29 at 1 month (P = .0034; 95% confidence interval [CI], 1.73-16.18) and 3.28 at 1 year (P = .0008; 95% CI, 1.63-6.59). Time to extubation and intensive care unit (ICU) and hospital readmissions were not different from the control cohort. Rapid ventricular response requiring treatment occurred in 4 patients during surgery and 7 after surgery, resulting in 3 ICU and 3 hospital readmissions. CONCLUSIONS: The results suggest that patients with atrial fibrillation may be at increased risk of mortality after liver transplantation. Optimization of medical therapy may decrease ICU and hospital readmission due to rapid ventricular response.