{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:09:23Z","timestamp":1788480563405,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T00:00:00Z","timestamp":1725235200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cardiac surgery is considered a contraindication in patients with advanced liver cirrhosis (LC) due to increased mortality and morbidity. There are limited data on the treatment strategy and management of this population. We aimed to present our strategy and evaluate the clinical outcome of cardiac surgery in patients with LC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our strategy was (i) to list patients for liver transplant (LT) at the time of cardiac surgery; (ii) to maintain high cardiopulmonary bypass (CPB) flow (index up to 3.0 L\/min\/m<jats:sup>2<\/jats:sup>) based on hyper\u2010dynamic states due to LC; and (iii) to proceed to LT if patients\u2019 liver function deteriorated with an increasing model for end\u2010stage liver disease Na (MELD\u2010Na) score after cardiac surgery. Thirteen patients (12 male and 1 female [mean age, 63.0]) with LC who underwent cardiac surgery between 2017 and 2024 were retrospectively analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients were listed for LT. Indications for cardiac surgery included coronary artery disease (<jats:italic>N<\/jats:italic>\u00a0=\u00a07), endocarditis (<jats:italic>N<\/jats:italic>\u00a0=\u00a02), and tricuspid regurgitation (<jats:italic>N<\/jats:italic>\u00a0=\u00a01), tricuspid stenosis (<jats:italic>N<\/jats:italic>\u00a0=\u00a01), mitral regurgitation (<jats:italic>N<\/jats:italic>\u00a0=\u00a01), and hypertrophic obstructive cardiomyopathy (<jats:italic>N<\/jats:italic>\u00a0=\u00a01). The Child\u2013Pugh score was A in five, B in six, and C in one patient. The procedure included coronary artery bypass grafting (<jats:italic>N<\/jats:italic>\u00a0=\u00a06), single valve surgery (mitral valve [<jats:italic>N<\/jats:italic>\u00a0=\u00a02] and tricuspid valve [<jats:italic>N<\/jats:italic>\u00a0=\u00a01]), concomitant aortic and tricuspid valve surgery (<jats:italic>N<\/jats:italic>\u00a0=\u00a02), and septal myectomy (<jats:italic>N<\/jats:italic>\u00a0=\u00a01). Two patients had a history of previous sternotomy. The perfusion index during CPB was 3.1\u00a0\u00b1\u00a00.5 L\/min\/m<jats:sup>2<\/jats:sup>. Postoperative complications include pleural effusion (<jats:italic>N<\/jats:italic>\u00a0=\u00a06), bleeding events (<jats:italic>N<\/jats:italic>\u00a0=\u00a03), acute kidney injury (<jats:italic>N<\/jats:italic>\u00a0=\u00a01), respiratory failure requiring tracheostomy (<jats:italic>N<\/jats:italic>\u00a0=\u00a02), tamponade (<jats:italic>N<\/jats:italic>\u00a0=\u00a01), and sternal infection (<jats:italic>N<\/jats:italic>\u00a0=\u00a01). There was no in\u2010hospital death. There was one remote death due to COVID\u201019 complication. Preoperative and postoperative highest MELD\u2010Na score among listed patients was 15.8\u00a0\u00b1\u00a05.1 and 19.3\u00a0\u00b1\u00a05.3, respectively. Five patients underwent LT (1, 5, 8, 16, and 24 months following cardiac surgery) and one patient remains on the list. Survival rates at 1 and 3 years are 100% and 75.0%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Cardiac surgery maintaining high CPB flow with LT backup is a feasible strategy in an otherwise inoperable patient population with an acceptable early and midterm survival when performed in a center with an experienced cardiac surgery and LT program.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15451","type":"journal-article","created":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T15:10:09Z","timestamp":1725289809000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Strategy and Outcomes of Cardiac Surgery in Patients With Cirrhosis: Comprehensive Approach With Liver Transplant Program"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7980-5036","authenticated-orcid":false,"given":"Junichi","family":"Shimamura","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Misawa","sequence":"additional","affiliation":[{"name":"Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0679-9699","authenticated-orcid":false,"given":"Roxana","family":"Bodin","sequence":"additional","affiliation":[{"name":"Division of Transplant Hepatology Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1504-3551","authenticated-orcid":false,"given":"Seigo","family":"Nishida","sequence":"additional","affiliation":[{"name":"Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8433-7214","authenticated-orcid":false,"given":"Sooyun","family":"Tavolacci","sequence":"additional","affiliation":[{"name":"Division of Radiation and Research Institute Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9390-2788","authenticated-orcid":false,"given":"Ramin","family":"Malekan","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-6902","authenticated-orcid":false,"given":"Steven","family":"Lansman","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Spielvogel","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0247-865X","authenticated-orcid":false,"given":"Suguru","family":"Ohira","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Department of Surgery Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02691.x"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21075"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21112"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2003.06.021"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs043"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.003"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.002"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2020.04.135"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20244"},{"issue":"1","key":"e_1_2_11_11_1","first-page":"32","article-title":"Liver Transplantation and Aortic Valve Replacement","volume":"2","author":"Davari H. 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