Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting

Authors

  • David Axelrod,

    1. Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Alan Koffron,

    Corresponding author
    1. Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
    • Division of Organ Transplantation, Feinberg School of Medicine, Galter Pavillion Suite 17-200, 675 North St. Clair, Chicago, IL 60611
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    • Telephone: 312-695-8900; FAX: 312-695-9194

  • Andre DeWolf,

    1. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Alfred Baker,

    1. Division of Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • John Fryer,

    1. Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Talia Baker,

    1. Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • James Frederiksen,

    1. Division of Cardiothoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Keith Horvath,

    1. Division of Cardiothoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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  • Micheal Abecassis

    1. Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Abstract

Advanced coronary artery disease (CAD) is increasingly common in patients awaiting orthotopic liver transplantation (OLT). Unfortunately, in patients whose coronary artery anatomy is not amenable to angioplasty, coronary artery bypass grafting (CABG) alone may precipitate hepatic decompensation. Thus, combined liver transplant and coronary artery bypass grafting (CABG-OLT) may be required to effectively treat both conditions. Clinical records were analyzed for 5 CABG-OLT procedures at a single institution. Operative indications, technical details, and postoperative course were determined for each patient. Patients undergoing CABG-OLT had a mean age of 57.8 years (range, 54-66) and were predominantly male (80%). All patients had significant 3-vessel coronary atherosclerotic disease with preserved left ventricular function. There were no intraoperative deaths. At mean 25 months of follow-up (range, 8.0-25) there was an 80% graft and patient survival. Overall average length of stay was 21 days (range, 7-59 days). In conclusion, CABG-OLT procedure appears to be safe and effective in the population of patients with advanced CAD and liver disease. In this series, patients appear to benefit from multidisciplinary preoperative evaluation, coordination between cardiac and transplant surgeons, careful graft selection, and use of sapheno-atrial veno-veno bypass. (Liver Transpl 2004;10:1386–1390.)

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