Transcatheter interventions for valvular heart diseases in liver cirrhosis patients

Taha, Ahmed; Misumida, Naoki; Grigorian, Alla; Tarantini, Giuseppe; Messerli, Adrian W.

doi:10.1016/j.tcm.2021.12.014

Cited by 9 publications

(5 citation statements)

References 67 publications

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“…We consider patients with severe mitral, tricuspid or aortic regurgitation in the setting of optimized volume status for transcutaneous intervention when feasible. There are currently limited data addressing percutaneous mitral or tricuspid valve intervention in this population, however, emerging data for percutaneous mitral intervention appears encouraging [26,27]. The presence of pulmonary hypertension is associated with worse outcomes in patients undergoing transcatheter edge-to-edge leaflet repair (TEER) [28].…”

Section: Valvular Diseasementioning

confidence: 99%

Cardiac evaluation of the liver transplant candidate

Possick,

Khungar,

Deshpande

2023

Current Opinion in Organ Transplantation

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Purpose of review This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure. Recent findings Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients. Summary Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.

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Section: Valvular Diseasementioning

confidence: 99%

Cardiac evaluation of the liver transplant candidate

Possick,

Khungar,

Deshpande

2023

Current Opinion in Organ Transplantation

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“…Severe aortic stenosis and moderate–severe aortic regurgitation have been shown to affect up to 5% and 0.65% of patients with cirrhosis, respectively. [ 12 ] Depending on its severity, aortic valve (AV) disease can cause hemodynamic instability during the LT surgery as well as significant long‐term consequences.…”

Section: Pre‐lt Cardiovascular Diseasementioning

confidence: 99%

“…However, the risk may be prohibitive in Child-Pugh score C disease. [12] LT in combination with valve or revascularization surgery has been performed in small numbers in some centers. [16] Comprehensive multidisciplinary discussion weighing the risks and benefits is critically important in these cases.…”

Section: Management Of Pre-lt Cardiovascular Diseasementioning

confidence: 99%

CAQ Corner: Cardiovascular and pulmonary evaluation of liver transplantation candidates: What you need to know for the board exam

Izzy

DuBrock

2022

Liver Transplantation

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“…Descriptions of cardiac surgery prior to LT or concomitantly estimate a mortality of more than 60% in Child-Pugh (CP) B and C (11,12). Therefore, the narrative review by T Ahmed entitled Transcatheter interventions for valvular heart diseases in liver cirrhosis patients was mostly indispensable (13).…”

Section: Introductionmentioning

confidence: 99%