title: Safety and efficacy of combined orthotopic liver transplantation and coronary artery bypass grafting.
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.
authors.affiliation: Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Alan
authors.initials: A
authors.lastname: Koffron
authors.forename: Andre
authors.initials: A
authors.lastname: Dewolf
authors.forename: Alfred
authors.initials: A
authors.lastname: Baker
authors.forename: John
authors.initials: J
authors.lastname: Fryer
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.forename: James
authors.initials: J
authors.lastname: Frederiksen
authors.forename: Keith
authors.initials: K
authors.lastname: Horvath
authors.forename: Micheal
authors.initials: M
authors.lastname: Abecassis
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D016896:Treatment Outcome