Rajiv Juneja1, Ajay Kumar2, Rajeev Ranjan1, PM Hemantlal1, Yatin Mehta1, Harpreet Wasir3, Vijay Vohra1, Naresh Trehan3
1 Institute of Critical Care and Anaesthesia, Medanta-the Medicity, Rishikesh, Uttarakhand, India
2 Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 Medanta Heart Institute, Medanta the Medicity, Rishikesh, Uttarakhand, India
Background: Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality.
Methods: The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies.
Results: The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies.
Conclusions: Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.
Department of Anaesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand - 249 202
Source of Support: None, Conflict of Interest: None
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