Mitigation of cardiac disease during liver transplantation through concomitant cardiac surgery and liver transplant: Pushing the boundaries of acceptable surgical candidacy

Introduction

The prevalence of cardiac disease is high in patients with liver cirrhosis, making it one of the leading causes of death in this population. However, the presence of cardiac diseases (coronary artery disease and valvular heart disease) often leads to disqualification of potential liver transplantation (LT) candidates, resulting in limited treatment options available for these complex patients. In recent years, some medical centers, including Cleveland Clinic, have provided concomitant cardiac surgery (CS) and LT to carefully selected patients.

Methods

A comprehensive literature review was conducted, compiling our experience and that of other medical centers performing concomitant CS and LT. We highlight Cleveland Clinic's approach for LT candidates with cardiac diseases. This includes a description of our initial evaluation, designed to detect cardiac diseases, followed by an explanation of our patient selection criteria and intraoperative strategies for concomitant CS and LT.

Conclusion

In patients with liver cirrhosis who are candidates for LT but also present cardiac diseases, a cautious evaluation by a multidisciplinary team is required to determine the feasibility of performing concomitant CS and LT. Available evidence suggests that this combined approach is a potential treatment option, offering acceptable postoperative outcomes and overall survival, despite the often perceived high-risk nature of this complex patient population.