Anesthesia for Combined Cardiac Surgery and Liver Transplant

Christopher Destephano, Barry A. Harrison, Monica Mordecai, Claudia C. Crawford, Timothy S J Shine, Winston R. Hewitt, Lawrence R. McBride, Michael J. Murray

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: To describe aspects of anesthesia for combined cardiac surgery and orthotopic liver transplant (OLT). Design: Retrospective case series. Setting: Hospital with cardiac surgery and liver transplant programs. Participants: Nine patients between September 1998 and July 2006. Intervention: Combined cardiac surgery and OLT. Measurement and Main Results: Demographic and outcome data were recorded for each patient. Multiple intraoperative parameters were collected at baseline, after induction of anesthesia, after cardiac surgery, and after OLT. Five patients underwent combined OLT and coronary artery bypass graft (CABG) surgery. Four patients underwent combined OLT and aortic valve replacement (AVR) to relieve aortic stenosis. One of these 4 patients also had a saphenous vein graft to the left anterior descending artery. The CABG/OLT patients had hypertension, diabetes, or both, and multiple coronary arteries were affected although ejection fraction was preserved. The 1 death in this group was unrelated to a coronary event. The AVR/OLT patients had aortic stenosis that met American Heart Association guidelines for AVR. One death, within 24 hours of surgery, was associated with severe pulmonary artery hypertension. The median transfusion volumes were 12 units of packed red blood cells, 22 units of fresh frozen plasma, and 30 units of platelets. Three of the 9 patients required renal replacement therapy postoperatively. The median duration of intubation was 2 days, and length of stay in the intensive care unit was 5.5 days. Conclusion: Combined cardiac and OLT surgery is complex and serious morbidity occurs, but successful outcomes are attainable.

Original languageEnglish (US)
Pages (from-to)285-292
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume24
Issue number2
DOIs
StatePublished - Apr 2010

Fingerprint

Thoracic Surgery
Anesthesia
Transplants
Liver
Aortic Valve
Aortic Valve Stenosis
Coronary Artery Bypass
Renal Replacement Therapy
Saphenous Vein
Pulmonary Hypertension
Intubation
Pulmonary Artery
Intensive Care Units
Length of Stay
Coronary Vessels
Blood Platelets
Arteries
Erythrocytes
Demography
Guidelines

Keywords

  • aortic stenosis
  • aortic valve replacement
  • coronary artery bypass graft
  • coronary artery disease
  • end-stage liver disease
  • orthotopic liver transplant

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Destephano, C., Harrison, B. A., Mordecai, M., Crawford, C. C., Shine, T. S. J., Hewitt, W. R., ... Murray, M. J. (2010). Anesthesia for Combined Cardiac Surgery and Liver Transplant. Journal of Cardiothoracic and Vascular Anesthesia, 24(2), 285-292. https://doi.org/10.1053/j.jvca.2009.10.014

Anesthesia for Combined Cardiac Surgery and Liver Transplant. / Destephano, Christopher; Harrison, Barry A.; Mordecai, Monica; Crawford, Claudia C.; Shine, Timothy S J; Hewitt, Winston R.; McBride, Lawrence R.; Murray, Michael J.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 24, No. 2, 04.2010, p. 285-292.

Research output: Contribution to journalArticle

Destephano, C, Harrison, BA, Mordecai, M, Crawford, CC, Shine, TSJ, Hewitt, WR, McBride, LR & Murray, MJ 2010, 'Anesthesia for Combined Cardiac Surgery and Liver Transplant', Journal of Cardiothoracic and Vascular Anesthesia, vol. 24, no. 2, pp. 285-292. https://doi.org/10.1053/j.jvca.2009.10.014
Destephano, Christopher ; Harrison, Barry A. ; Mordecai, Monica ; Crawford, Claudia C. ; Shine, Timothy S J ; Hewitt, Winston R. ; McBride, Lawrence R. ; Murray, Michael J. / Anesthesia for Combined Cardiac Surgery and Liver Transplant. In: Journal of Cardiothoracic and Vascular Anesthesia. 2010 ; Vol. 24, No. 2. pp. 285-292.
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