title: Transfemoral Transcatheter Aortic Valve Replacement for Mixed Aortic Valve Disease in Child's Class C Liver Disease Prior to Orthotopic Liver Transplantation: A Case Report.
abstract: The American Association for the Study of Liver Diseases practice guidelines list severe cardiac disease as a contraindication to liver transplantation. Transcatheter aortic valve replacement has been shown to decrease all-cause mortality in patients with severe aortic stenosis who are not considered candidates for surgical aortic valve replacement. We report our experience of liver transplantation in a patient with severe aortic stenosis and moderate aortic insufficiency who underwent transcatheter aortic valve replacement with Child-Pugh Class C disease at a Model For End-Stage Liver Disease score of 29. The patient had a difficult post procedure course that was successfully medically managed. After liver transplantation the patient was discharged to home on postoperative day 11. The combination of cardiac disease and end stage liver disease is challenging but these patients can have a successful outcome despite very severe illness.
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA barbara.wilkey@ucdenver.edu.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Wilkey
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Hanson
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: T Brett
authors.initials: TB
authors.lastname: Reece
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Forman
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Burton
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Matt J
authors.initials: MJ
authors.lastname: Fiegel
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: Trevor L
authors.initials: TL
authors.lastname: Nydam
authors.affiliation: University of Colorado Denver, Aurora, Colorado, USA.
authors.forename: M Susan
authors.initials: MS
authors.lastname: Mandell
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D005263:Femoral Artery; D006801:Humans; D016031:Liver Transplantation; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000601:surgery*; D013916:Thrombelastography; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: aortic valve replacement; cardiac anesthesia; cardiac surgery; coagulopathy; heparin; platelet function