Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

Abstract

Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.

High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

“…The numbers of intraoperative thrombotic events during cardiac surgery and liver transplantation have been increasing since 2001 [10,52], which is likely the result of the more widespread use of intraoperative TEE, permitting a prompt diagnosis of systemic thrombosis. Thrombotic events might have been previously considered as a ''protamine reaction'' and thus underreported before the TEE era.…”

“…However, DHCA was used in only 9 (26.5%) of 34 thrombosis cases ( Table 2). The evidence for increased postsurgical thrombotic risks associated with factor V Leiden mutation is insufficient [10,[65][66][67]. Once systemic thrombi are formed in the presence of any antifibrinolytic agent, it would be difficult to break them down because they are more resistant to fibrinolysis.…”

“…Relevant thrombotic events in cardiothoracic surgery were searched using the Ovid MEDLINE from 1968 to 2011 (last entry, 11 May 2011) and the EMBASE from 1968 to 2011 (last entry, 11 May 2011), with no language restrictions [10]. The keywords for search were as follows: (intra)pulmonary thrombosis, pulmonary embolism, pulmonary infarction, lung embolism, (intra)cardiac thrombosis, cardiac thrombi, in combination with CPB, extracorporeal membrane oxygenation (ECMO), DHCA, or cardiac surgery.…”

Use of sildenafil in a liver transplant recipient with acute pulmonary embolism

“…As for LT recipients, the incidence of PE may be underestimated. In fact, various articles have demonstrated intraoperative PE [25,26]. In a series of 299 patients who underwent 342 LTs at our center between 1989 and 1995, eleven had documented deep venous thrombosis including three who developed PE [11].…”

Devastating intracardiac and aortic thrombosis: a case report of apparent catastrophic antiphospholipid syndrome during liver transplantation

“…Fewer than 80 cases of intraoperative intracardiac and pulmonary thromboembolism have been described during liver transplantation [1]. The great majority of these cases involved the right heart.…”