Our Summary

This research paper looks at how to best deal with heart disease in patients who need a liver transplant. Heart disease is one of the main causes of death after liver transplant surgery, so it’s important to treat it before the transplant. There are two main ways to do this: with a procedure called percutaneous coronary intervention (PCI), which uses a stent to open up the blood vessels, or with coronary artery bypass grafting (CABG), which is a type of heart surgery.

The study looked back at patients who had one of these heart treatments before getting a liver transplant. Out of 51 patients, 29 had a heart procedure. Most had a diagnostic PCI, a few had a therapeutic PCI with a stent, and two had a failed PCI and went on to have CABG before their liver transplant. The patients were mostly men, around 60 years old, with cirrhosis (liver disease). The two who had CABG had their liver transplant during the same hospital stay, with a 13- and 18-day gap between the heart surgery and the transplant. Both transplants came from living donors. No patients died.

The researchers concluded that if PCI doesn’t work, CABG can be a safe and effective treatment for heart disease in patients who also need a liver transplant. They also suggest that using a living donor for the liver transplant could be a good option for these patients, in case their liver disease gets worse.

FAQs

  1. What were the findings of the study conducted on patients who underwent cardiac intervention before liver transplantation?
  2. Is coronary artery bypass grafting (CABG) a safe treatment option for cirrhotic patients preparing for liver transplantation?
  3. What is the suggested backup plan for patients who develop hepatic decompensation after undergoing CABG?

Doctor’s Tip

A doctor might tell a patient undergoing CABG (coronary artery bypass grafting) to follow a healthy diet and exercise regimen post-surgery to promote heart health and prevent future cardiovascular complications. They may also advise the patient to attend regular follow-up appointments and take prescribed medications as directed to ensure optimal recovery and long-term success of the procedure.

Suitable For

Patients who are typically recommended for coronary artery bypass grafting (CABG) include those with significant coronary artery disease who have failed percutaneous coronary intervention (PCI) or who have complex coronary anatomy that is not amenable to PCI. In the context of liver transplantation, CABG may be considered in patients with end-stage liver disease who require revascularization for their coronary artery disease before undergoing liver transplant surgery. This study specifically focused on cirrhotic patients who underwent CABG as a preparation for liver transplantation, highlighting the importance of a thorough cardiac evaluation in this patient population.

Timeline

Before CABG:

  1. Patient undergoes a thorough cardiac evaluation to assess the extent of coronary artery disease.
  2. Patient may undergo diagnostic tests such as coronary angiography to determine the severity of blockages in the coronary arteries.
  3. If deemed necessary, patient may undergo percutaneous coronary intervention (PCI) with stent placement to improve blood flow to the heart.
  4. If PCI is unsuccessful, patient may be recommended for coronary artery bypass grafting (CABG) surgery.
  5. Patient undergoes CABG surgery to reroute blood flow around the blocked coronary arteries to improve blood flow to the heart muscle.

After CABG:

  1. Patient is monitored closely in the intensive care unit (ICU) immediately after surgery.
  2. Patient may experience pain, fatigue, and discomfort in the chest area post-surgery.
  3. Patient undergoes cardiac rehabilitation to improve heart function and overall physical health.
  4. Patient is advised to make lifestyle changes such as following a healthy diet, regular exercise, and quitting smoking to prevent future cardiovascular complications.
  5. Patient undergoes regular follow-up appointments with their healthcare provider to monitor their progress and adjust their treatment plan as needed.

What to Ask Your Doctor

  1. What are the benefits of undergoing coronary artery bypass grafting (CABG) before liver transplantation for patients with coronary artery disease?

  2. What is the success rate of CABG for patients with cirrhosis who are preparing for liver transplantation?

  3. What are the risks and potential complications associated with CABG in patients with end-stage liver disease?

  4. How long is the recovery period after undergoing CABG before proceeding to liver transplantation?

  5. Are there any specific guidelines or precautions that need to be followed after undergoing CABG and before liver transplantation?

  6. How will undergoing CABG affect the overall success of the liver transplantation surgery?

  7. Are there any alternative treatment options to CABG for patients with coronary artery disease who are preparing for liver transplantation?

  8. What is the long-term outlook for patients who undergo CABG before liver transplantation?

  9. How will undergoing CABG affect the management of other medical conditions or medications that the patient may be taking?

  10. Are there any specific follow-up appointments or tests that will be necessary after undergoing CABG and before liver transplantation?

Reference

Authors: Imam A, Karatas C, Mecit N, Kalayoglu M, Kanmaz T. Journal: Transplant Proc. 2021 Jun;53(5):1622-1625. doi: 10.1016/j.transproceed.2021.03.012. Epub 2021 Apr 21. PMID: 33892932