Liver Transplantation and Aortic Valve Replacement

Surgical procedures involving heart and liver are rare and have been limited to either combinedheart and liver transplantation or coronary artery bypass graft surgery (CABG) or aortic valvesurgery and orthotopic liver transplantation (OLT). Aortic valve replacement (AVR) and pulmonaryvalve vegetectomy for bacterial endocarditis after OLT have also been reported. Thereare only five cases with aortic stenosis and cirrhosis reported to have combined AVR and livertransplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because ofbleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing.Herein, we report on a case and management analysis of combined sequential AVR, and OLTin a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiographydetected severe aortic insufficiency (AI) with enlarged left ventricle. Due to severeAI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallicAVR. 4 months later, he received OLT. Both operations were successful and uneventful. PrioritizingAVR before OLT was successful in this patient. However, each patient must be evaluatedindividually and multiple factors should be assessed in pre-operation evaluation.