title: Anesthesia for combined cardiac surgery and liver transplant.
abstract: OBJECTIVE
  To describe aspects of anesthesia for combined cardiac surgery and orthotopic liver transplant (OLT).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Hospital with cardiac surgery and liver transplant programs.
  
  
  METHODS
  Nine patients between September 1998 and July 2006.
  
  
  METHODS
  Combined cardiac surgery and OLT.
  
  
  RESULTS
  Demographic and outcome data were recorded for each patient. Multiple intraoperative parameters were collected at baseline, after induction of anesthesia, after cardiac surgery, and after OLT. Five patients underwent combined OLT and coronary artery bypass graft (CABG) surgery. Four patients underwent combined OLT and aortic valve replacement (AVR) to relieve aortic stenosis. One of these 4 patients also had a saphenous vein graft to the left anterior descending artery. The CABG/OLT patients had hypertension, diabetes, or both, and multiple coronary arteries were affected although ejection fraction was preserved. The 1 death in this group was unrelated to a coronary event. The AVR/OLT patients had aortic stenosis that met American Heart Association guidelines for AVR. One death, within 24 hours of surgery, was associated with severe pulmonary artery hypertension. The median transfusion volumes were 12 units of packed red blood cells, 22 units of fresh frozen plasma, and 30 units of platelets. Three of the 9 patients required renal replacement therapy postoperatively. The median duration of intubation was 2 days, and length of stay in the intensive care unit was 5.5 days.
  
  
  CONCLUSIONS
  Combined cardiac and OLT surgery is complex and serious morbidity occurs, but successful outcomes are attainable.
authors.affiliation: Mayo Medical School, College of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: DeStephano
authors.forename: Barry A
authors.initials: BA
authors.lastname: Harrison
authors.forename: Monica
authors.initials: M
authors.lastname: Mordecai
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Crawford
authors.forename: Timothy S J
authors.initials: TS
authors.lastname: Shine
authors.forename: Winston R
authors.initials: WR
authors.lastname: Hewitt
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: McBride
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Murray
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors