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

David Axelrod, Alan Koffron, Andre DeWolf, Alfred Baker, John Fryer, Talia Baker, James Frederiksen, Keith Horvath, Micheal Abecassis

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1386-1390
Number of pages5
JournalLiver Transplantation
Volume10
Issue number11
DOIs
StatePublished - Nov 1 2004

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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    Axelrod, D., Koffron, A., DeWolf, A., Baker, A., Fryer, J., Baker, T., Frederiksen, J., Horvath, K., & Abecassis, M. (2004). Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting. Liver Transplantation, 10(11), 1386-1390. https://doi.org/10.1002/lt.20244