Aortic valve-sparing procedure\u2014a durable choice in liver transplantation recipient

Paola Carrai,Stefania Petruccelli,Stefano Pratali,Paolo De Simone,Andrea De Martino,Uberto Bortolotti

doi:10.1007/s11748-020-01434-y

Abstract

A 44-year old man with aortic regurgitation and aneurysm of the ascending aorta underwent an aortic valve-sparing procedure as a durable treatment before liver transplantation. Since patients with chronic liver failure are at high risk of hemorrhagic complications at time of major surgery, while management of warfarin administration may still represent a concern, the choice of a cardiac procedure which avoids any anticoagulant treatment appeared justified.

Highlights

Valve-sparing procedures are currently the treatment of choice for patients with aortic regurgitation and aneurysm of root and ascending aorta, since repairing the native aortic valve combines the advantages of long-term valve durability with avoidance of anticoagulant treatment [1]
A valve-sparing procedure was performed according to the technique described by El Khoury et al [4], using a 28 mm Valsalva graft (Vascutek Ltd., Inchinnan, Scotland), with reimplantation of the aortic valve inside the graft and reattachment of the coronary buttons, while the right coronary artery was grafted with a segment of saphenous vein
At 6-months follow-up, an initial recovery of ejection fraction (50%) and decrease of left ventricular diameter (51 mm) were observed. 8 months thereafter the patient was listed for deceased donor liver transplantation (LT)

Summary

Introduction

Valve-sparing procedures are currently the treatment of choice for patients with aortic regurgitation and aneurysm of root and ascending aorta, since repairing the native aortic valve combines the advantages of long-term valve durability with avoidance of anticoagulant treatment [1]. An angio-computed tomography confirmed the presence of an aortic aneurysm, while angiography showed an enlarged aorta with 57 mm in the largest tract of the ascending aorta and 55 mm at the sino-tubular junction, 50 mm at the root, 36 mm at ventriculo-aortic junction (Fig. 1), and presence of right coronary artery stenosis. His blood tests showed marked thrombocytopenia (45,000/μL), prolonged partial prothrombin time, and reduced prothrombin activity (77%), AST 73 U/L, ALT 83 U/L, bilirubin 0.9 mg/dL. The patient is alive with no evidence of recurrent HBV disease and normal aortic valve function

Discussion

Findings

Procedure