Cardiac surgery in children with end-stage liver disease awaiting liver transplantation.
BACKGROUND
Cardiac repair for congenital heart disease in children awaiting liver transplantation presents unique therapeutic challenges and dilemmas. We tested the hypothesis that operations in these children requiring cardiopulmonary bypass (CPB) were not associated with prohibitive morbidity and mortality.


METHODS
Over the last 10 years (1994-2004), five infants were identified in our database with end-stage liver disease and awaiting liver transplantation that required cardiac surgery. Primary end point for the study was mortality. Secondary end points included morbidity and time to liver transplantation. The new pediatric end-stage liver disease (PELD) model was used to score liver disease severity.


RESULTS
Three boys and two girls with mean age of 8.6 months (range, 1.5-21 months) and mean PELD of 18.0 (range, 10-29) required CPB for repair. The only early mortality in the series occurred after cardiac arrest during creation of a central shunt. The child expired two days later despite extracorporeal membrane oxygenation support. The patient had important myocardial hypertrophy. All other patients survived and underwent successful liver transplantation.


CONCLUSIONS
Children with significant congenital heart disease awaiting liver transplantation can undergo safe cardiac repair with judicious perioperative support thereby reducing the risks of subsequent liver transplantation.
Odim
Jonah N K
JN
Division of Cardiothoracic Surgery, David Geffen School of Medicine, University of California-Los Angeles, California 90095-1741, USA. jodim@mednet.ucla.edu
Wu
Jeffrey
J
Laks
Hillel
H
Banerji
Anamika
A
Drant
Stacey
S
D015897:Comorbidity; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists