title: Transcatheter aortic valve replacement in patients with cirrhosis.
abstract: BACKGROUND
  Patients with cirrhosis who undergo cardiac operation with extracorporeal circulation are at high risk for operative morbidity and mortality. Transcatheter aortic valve replacement (TAVR) can obviate the need for cardiopulmonary bypass and may reduce operative morbidity in comparison to standard aortic valve replacement (SAVR) in select patients.
  
  
  METHODS
  Review of 18 patients with aortic valve stenosis and cirrhosis treated with TAVR (n=6) or SAVR (n=12). Patient age was 71 years (58 to 83) and STS Predicted Risk of Mortality was 3.2% (0.7 to 12.3). There were 15 males (83%). Child-Turcotte-Pugh stage was A in 10 patients (56%), B in four (22%), and C in two (11%); the median MELD score was nine (7 to 14).
  
  
  RESULTS
  TAVR was successful in all patients without the need for mechanical or cardiopulmonary bypass support. Blood transfusion occurred in four patients (67%) in the TAVR group and in the entire SAVR group. No deaths occurred in the TAVR group, and two (17%) occurred in the SAVR group. Operative complications occurred in two patients (33%) in TAVR group and in eight (67%) in the SAVR group. Hospital stay was five days (3 to 10) in the TAVR group and six (3 to 38) in the SAVR group. All TAVR patients were alive at last follow-up of 219 days (29 to 723), while only five were alive in the SAVR group at 228 days (36 to 719).
  
  
  CONCLUSIONS
  Our initial experience with TAVR in patients with cirrhosis is encouraging. The technique may be a viable alternative to SAVR in this high-risk subset of patients.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.forename: Russel H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D062906:Cardiac Catheters; D002315:Cardiopulmonary Bypass; D005260:Female; D005355:Fibrosis / Q000150:complications*; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors