Long-Term Cardiac Morbidity and Mortality in Patients With Aortic Valve Disease Following Liver Transplantation: A Case Matching Study

Nicolau‐Raducu, Ramona; Marshall, Thomas; Patel, Hamang; Ural, Kelly; Koveleskie, Joseph; Smith, Susan; Ganier, Donald; Evans, Beth; Fish, Brian L.; Daly, William J.; Cohen, Ari J.; Loss, George E.; Bokhari, Amjad; Nossaman, Bobby D.

doi:10.1177/1089253217708034

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…A retrospective study does not find increased mortality in LT candidates with aortic stenosis (170). None of the patients in this study has severe aortic stenosis and LT is typically not offered to patients with severe aortic stenosis.…”

Section: Contrast-enhanced Echocardiography (Ce-tte)mentioning

confidence: 65%

Evaluation of liver transplant candidates with non-alcoholic steatohepatitis

Esteban¹,

Asgharpour²

2022

Transl Gastroenterol Hepatol

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Non-alcoholic fatty liver disease (NAFLD) and liver transplantation (LT) NAFLD affects 75 to 100 million Americans and up to 25% of the global population (1,2). The prevalence of NAFLD is expected to increase by 60% in the next decade, in parallel with the obesity epidemic, making NAFLD the most common chronic liver disease (3,4). Non-alcoholic steatohepatitis (NASH), affecting 10-30% of patients with NAFLD, is the progressive form of NAFLD that leads to cirrhosis and is associated with cardiovascular (CV) and liver-related morbidity and mortality (5). Hepatic fibrosis is the most important predictor of mortality in NASH (6).One in four NASH patients will progress to cirrhosis over 8 years on average (7). Patients with NASH-related cirrhosis are at increased risk of hepatocellular carcinoma (HCC), occurring at an annual incidence of 0.3-4.3% (8).NASH is currently the 2 nd most common indication for LT in the U.S., but is the fastest growing indication for LT and simultaneous liver-kidney (SLK) transplants and the fastest growing cause of HCC in LT recipients (9-13). NASH is expected to overtake chronic hepatitis C as the most common indication for LT. In the last two decades, waitlist registrations, liver transplants, and SLK transplants for NASH increased 3-fold each (9-11), while the number of LT registrants and recipients with HCC attributable to

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Section: Contrast-enhanced Echocardiography (Ce-tte)mentioning

confidence: 65%

Evaluation of liver transplant candidates with non-alcoholic steatohepatitis

Esteban¹,

Asgharpour²

2022

Transl Gastroenterol Hepatol

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“…Additionally, the severity of aortic stenosis has been found to correspond with perioperative mortality in patients undergoing noncardiac surgery[ 102 ]. Additionally, patients with uncorrected severe aortic stenosis undergoing LT have been found to have a higher rate of cardiac complications, including cardiac death, myocardial infarction, and requirement of aortic valve replacement in the post-transplant period compared to patients without valvular disease[ 101 , 103 ]. As per the AHA/ACC 2014 guidelines, elevated-risk elective noncardiac surgery is reasonable to perform in patients with either severe asymptomatic aortic stenosis, mitral regurgitation, or severe asymptomatic aortic regurgitation with normal LVEF[ 104 ].…”

Section: Clinical Entitiesmentioning

confidence: 99%

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Nagraj¹,

Peppas²,

Guerrero³

et al. 2022

WJT

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Cardiovascular diseases (CVD) form a principal consideration in patients with end-stage liver disease (ESLD) undergoing evaluation for liver transplant (LT) with prognostic implications in the peri- and post-transplant periods. As the predominant etiology of ESLD continues to evolve, addressing CVD in these patients has become increasingly relevant. Likewise, as the number of LTs increase by the year, the proportion of older adults on the waiting list with competing comorbidities increase, and the demographics of LT candidates evolve with parallel increases in their CVD risk profiles. The primary goal of cardiac risk assessment is to preemptively reduce the risk of cardiovascular morbidity and mortality that may arise from hemodynamic stress in the peri- and post-transplant periods. The complex hemodynamics shared by ESLD patients in the pre-transplant period with adverse cardiovascular events occurring in only some of these recipients continue to challenge currently available guidelines and their uniform applicability. This review focusses on cardiac assessment of LT candidates in a stepwise manner with special emphasis on preoperative patient optimization. We hope that this will reinforce the importance of cardiovascular optimization prior to LT, prevent futile LT in those with advanced CVD beyond the stage of optimization, and thereby use the finite resources prudently.

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“…In a study looking at long-term cardiac morbidity and mortality in LT recipients with aortic valvular heart disease including those who have had valve replacement, it was observed that this group had significant cardiac complications that included myocardial infarction, postoperative SAVR, and cardiac death in 1 to 3 years post-OLT. 3 Since the first publication of combined AVR and LT in 2001, 4 only few cases have been reported. Transcatheter aortic valve implantation (TAVI) is currently the treatment modality of choice for patients with symptomatic severe AS who are inoperable or at high risk for SAVR.…”

Section: Introductionmentioning

confidence: 99%

“…Since the first publication of combined AVR and LT in 2001, 4 only few cases have been reported. Transcatheter aortic valve implantation (TAVI) is currently the treatment modality of choice for patients with symptomatic severe AS who are inoperable or at high risk for SAVR.…”

Section: Introductionmentioning

confidence: 99%

Living Donor Liver Transplantation Following Transcatheter Aortic Valve Implantation for Aortic Valvular Disease

Kaliamoorthy

Rajakumar

Varghese³

et al. 2019

Semin Cardiothorac Vasc Anesth

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Over the last few decades, outcomes with living donor liver transplantation (LDLT) have improved significantly. This has resulted in patients who were denied liver transplantation previously, due to various comorbidities and high risk, now being considered for LDLT. This includes patients with severe valvular heart disease such as aortic stenosis. These patients require aortic valve replacement to help cope with significant perioperative hemodynamic changes. High-risk cardiac procedures like aortic valve replacement are associated with serious perioperative morbidity and mortality in patients with end-stage liver disease. Since the advent of transcatheter aortic valve implantation (TAVI) in 2002, there have been a few case reports of its successful use prior to deceased donor liver transplantation, but there is no literature on this procedure before LDLT. In this article, we report our experience with 2 patients, the first patient with infective endocarditis-induced acute aortic regurgitation and the second patient with bicuspid aortic stenosis who underwent uneventful TAVI followed by successful LDLT. In conclusion, with the increasing expertise and experience in this procedure, an increasing number of potential recipients, previously considered as high-risk transplant candidates, can now be offered liver transplantation by performing pretransplant TAVI.

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Long-Term Cardiac Morbidity and Mortality in Patients With Aortic Valve Disease Following Liver Transplantation: A Case Matching Study

Abstract: Patients with pretransplant AV replacement or AS have significant cardiac complications (myocardial infarction, AV replacement, or cardiac death) in 1 to 3 years post-OLT.

Cited by 6 publications

References 30 publications

Evaluation of liver transplant candidates with non-alcoholic steatohepatitis

Evaluation of liver transplant candidates with non-alcoholic steatohepatitis

Cardiac risk stratification of the liver transplant candidate: A comprehensive review

Living Donor Liver Transplantation Following Transcatheter Aortic Valve Implantation for Aortic Valvular Disease

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