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Annie FH, Belcher AM, Manivannan PKR, Elashery AR. Impact of TAVR on patients with severe aortic stenosis and liver cirrhosis. Am J Physiol Heart Circ Physiol 2023; 325:H539-H544. [PMID: 37477691 PMCID: PMC10538975 DOI: 10.1152/ajpheart.00342.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
We sought to assess the impact of transcatheter aortic valve replacement (TAVR) on patients that have both severe aortic stenosis (SAS) and liver cirrhosis on mortality at 365 days after index event. We identified 19,210 patients that met inclusion criteria using the TriNetX database, consisting of data from 58 large healthcare organizations collected between 1 January 2010 and 24 February 2022. Of those patients, 1,283 (3.2%) had SAS with liver cirrhosis that had a TAVR, and 19,210 (96.8%) had SAS with liver cirrhosis that did not have a TAVR. We analyzed the data to compare all-cause mortality at 365 days using the TriNetX web platform. In addition, we conducted propensity score matching (PSM) to reduce the effects of confounders between the two groups. Patients with SAS and liver cirrhosis that had a TAVR were older (72.4 ± 9.7 vs. 68.0 ± 11.8, P < 0.001), and they had higher rates of heart failure (71.2 vs. 34.5%, P < 0.001), coronary artery disease (72.0 vs. 31.2%, P < 0.001), diabetes (52.5 vs. 41.2%, P < 0.001), and chronic kidney disease (43.8 vs. 30.1%, P < 0.001) compared with patients with SAS and liver cirrhosis without TAVR. PSM created two well-matched cohorts of 1,269 patients each. The TAVR group had a lower mortality rate compared with the no TAVR group (22.5 vs. 34.8%, P < 0.0001) at 365 days. This was confirmed using a log-rank test. Given these data, it appears that there is a mortality benefit associated with TAVR in patients with SAS and liver cirrhosis.NEW & NOTEWORTHY Risk calculators used to predict unfavorable surgical outcomes could flag a patient as ineligible for transcatheter aortic valve replacement (TAVR) based on the presence of liver cirrhosis. Our data analysis suggests that performing a TAVR to treat severe aortic stenosis in patients with liver cirrhosis could decrease their mortality risk as opposed to not performing a TAVR. Careful consideration should be given to this patient population to ensure the best quality of life and long-term outcome.
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Affiliation(s)
- Frank H Annie
- Department of Cardiology, CAMC Health Education and Research Institute, Charleston, West Virginia, United States
| | - Adam M Belcher
- Department of Cardiology, CAMC Health Education and Research Institute, Charleston, West Virginia, United States
| | | | - Ahmad Ramy Elashery
- CAMC Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia, United States
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Kaafarani M, Shamma O, Jafri SM. Transcatheter Aortic Valve Replacement Restoring Candidacy for Liver Transplant in Patients With Cirrhosis. ACG Case Rep J 2023; 10:e01102. [PMID: 37601302 PMCID: PMC10435020 DOI: 10.14309/crj.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/10/2023] [Accepted: 06/15/2023] [Indexed: 08/22/2023] Open
Abstract
Guidelines for preoperative workup for an orthotopic liver transplant often rule out patients with severe aortic stenosis as transplant candidates. This case illustrates the potential of transcatheter aortic valve replacement (TAVR) as a bridge for liver transplants in cirrhotic patients with severe aortic stenosis. The 1-year and 2-year post-liver transplant follow-ups showed no complications in the patient's prosthetic aortic valves, and graft survival was 100% with no evidence of rejection. Notable post-transplant recovery involved medical complications that were not related to the liver function or surgical procedure.
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Affiliation(s)
| | - Omar Shamma
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI
| | - Syed-Mohammed Jafri
- Department of Gastroenterology and Hepatology, Henry Ford Health System, Detroit, MI
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Kazimi M, Beydullayev K, Farajov E, Shindiyeva S, Jafarova S, Khalilov Z, Nadirov T, Abdulkarimov V, Mammadov A, Farzaliyeva A, Kazımzade N, Musayev K, Vatansever S. Simultaneous Live Donor Liver Transplantation, Aortic Valve Replacement, and Atrial Septal Defect Repair in a Patient With End Stage Liver Disease: A Case Report. Transplant Proc 2023; 55:672-675. [PMID: 36959029 DOI: 10.1016/j.transproceed.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/19/2023] [Indexed: 03/25/2023]
Abstract
Valvular heart disease creates an important barrier for orthotopic liver transplantation in patients with end-stage liver disease and increases mortality. Selection of the appropriate surgical scheme and adequate postoperative management can be lifesaving in these cases. This study presents a 32-year-old man diagnosed with hepatitis C-associated cirrhosis and severe aortic regurgitation due to subacute bacterial endocarditis. Initially, simultaneous aortic valve replacement (AVR) and live donor liver transplantation (LDLT) was planned. However, intraoperative transesophageal echocardiography revealed an additional atrial septal defect (ASD) and AVR, ASD repair, and LDLT surgery were performed. During the 2-year follow-up period, there were no early or late complications. To the best of our knowledge, this is the first patient to have simultaneous AVR, ASD repair, and LDLT surgery. Additionally, the present case is also unique in being the first person in the Republic of Azerbaijan to undergo concomitant cardiac surgery and LDLT.
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Affiliation(s)
- Mirjalal Kazimi
- Department of Surgery and Organ Transplantology, Central Customs Hospital, Baku, Azerbaijan
| | - Kamran Beydullayev
- Department of Surgery and Organ Transplantology, Central Customs Hospital, Baku, Azerbaijan
| | - Elnur Farajov
- Department of Surgery and Organ Transplantology, Central Customs Hospital, Baku, Azerbaijan
| | - Saida Shindiyeva
- Department of Surgery and Organ Transplantology, Central Customs Hospital, Baku, Azerbaijan
| | - Shahnaz Jafarova
- Department of Surgery and Organ Transplantology, Central Customs Hospital, Baku, Azerbaijan
| | - Zaur Khalilov
- Department of Surgery and Organ Transplantology, Central Clinic Hospital, Baku, Azerbaijan
| | - Tariyel Nadirov
- Department of Surgery and Organ Transplantology, Central Clinic Hospital, Baku, Azerbaijan
| | - Vugar Abdulkarimov
- Department of Anesthesiology and Reanimation, Central Clinic Hospital, Baku, Azerbaijan
| | - Asaf Mammadov
- Department of Anesthesiology and Reanimation, Central Clinic Hospital, Baku, Azerbaijan
| | - Aygun Farzaliyeva
- Department of Anesthesiology and Reanimation, Central Clinic Hospital, Baku, Azerbaijan
| | - Nigar Kazımzade
- Department of Cardiovascular Surgery, Central Clinic Hospital, Baku, Azerbaijan
| | - Kamran Musayev
- Department of Cardiovascular Surgery, Central Clinic Hospital, Baku, Azerbaijan
| | - Safa Vatansever
- Department of General Surgery, Izmir University of Economics Medical Point Hospital, Izmir, Turkey.
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Ahmed T, Misumida N, Grigorian A, Tarantini G, Messerli AW. Transcatheter interventions for valvular heart diseases in liver cirrhosis patients. Trends Cardiovasc Med 2021; 33:242-249. [PMID: 34974163 DOI: 10.1016/j.tcm.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
There is an increasing prevalence of patients who have both liver cirrhosis (LC) and severe valvular heart disease. This combination typically poses prohibitive risk for liver transplantation. LC related malnourishment, hypoalbuminemia and hyperdynamic circulation places patients with severe LC at higher rates for significant bleeding and/or thrombosis, as well as infectious and renal complications, after either surgical or transcatheter valvular interventions. Although there remains scarce comparative evidence, the preponderance of data suggest that percutaneous strategies are preferred over surgical ones. A multidisciplinary team is ideal for identifying those patients with LC who would benefit from transcatheter valvular heart interventions.
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Affiliation(s)
- Taha Ahmed
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Naoki Misumida
- Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA
| | - Alla Grigorian
- Department of Hepatology, University of Kentucky, Lexington, KY, USA
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Adrian W Messerli
- Department of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, USA.
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Wallen TJ, Arnaoutakis GJ, Beaver T, Pelaez A, Chandrashekaran S, Shahmohammadi A, Emtiazjoo AM, Spiess B, Pipkin M, Machuca TN. Successful bridge to lung transplantation with transcatheter aortic valve replacement. Am J Transplant 2020; 20:3658-3661. [PMID: 32506577 DOI: 10.1111/ajt.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
End-stage lung disease and advanced cardiac conditions are frequently seen together and represent a clinical dilemma. Even though both issues may be amenable to surgical management, combining lung transplant with surgical valve repair is rarely done and theoretically associated with increased morbidity and mortality risks, especially in elderly patients. Here, we describe 2 patients presenting with end-stage lung disease and significant aortic stenosis who were successfully bridged to lung transplant via transcatheter aortic valve replacement. Patient 1 was a 66-year-old man who underwent a double lung transplant 56 days after transcatheter aortic valve replacement. Patient 2 was a 70-year-old man who underwent a single right lung transplant 103 days after transcatheter aortic valve replacement. Both patients had uneventful postoperative courses and are alive at the 1-year time point with excellent performance status. This report suggests that transcatheter aortic valve replacement may favorably impact lung transplant candidacy for patients with end-stage lung disease in the setting of severe aortic stenosis, likely representing a better alternative to concomitant aortic valve replacement and lung transplant in elderly patients.
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Affiliation(s)
- Tyler J Wallen
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Thomas Beaver
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Andres Pelaez
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Satish Chandrashekaran
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Abbas Shahmohammadi
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Amir M Emtiazjoo
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Bruce Spiess
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, The University of Florida, Gainesville, Florida, USA
| | - Mauricio Pipkin
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Tiago N Machuca
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
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