Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease
Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease
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DOI：
10.1155/2014/325136
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发表时间：
2014-01-01
影响因子：
0.6
通讯作者：
Zajarias, Alan
中科院分区：
文献类型：
--
作者：
Coverstone, Edward;Korenblat, Kevin;Zajarias, Alan
严重主动脉瓣狭窄和终末期肝病的组合增加了外科主动脉瓣置换术或原位肝移植术的发病率和死亡率，导致手术风险过高。我们建议在原位肝移植前进行分期球囊主动脉瓣成形术，作为最终主动脉瓣置换术的桥梁。在2010年至2012年期间，4名患有严重主动脉瓣狭窄和终末期肝病的患者接受了分期球囊主动脉瓣成形术，随后进行了原位肝移植。由于合并症，所有患者都被认为是不适合进行肝移植或主动脉瓣手术的候选人。1例患者死于瓣周脓肿并发症。3例患者继续成功植入移植物，功能和手术恢复。3例患者中有2例进行了确定性外科主动脉瓣置换术，其余患者目前正在接受评价。在这个病例系列中，我们提出了一种新的方法，肝移植前的球囊主动脉瓣成形术作为一个潜在的桥梁，以确定性治疗严重的主动脉瓣狭窄的终末期肝脏患者。
The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient.