P048: CARDIOVASCULAR OUTCOME IN ELDERLY PATIENTS WITH EF<55% PRESENTING FOR LIVER TRANSPLANT: CASE SERIES
Mohammad Z Khan, MD; Shashidhar Manchegowda, MD; Rofayda Gad, MD; Nathalia Torres Buendia, MD; Ramona Nicolau-Raducu, MD; Fouad G Souki, MD; Jackson Memorial Hospital
Introduction: Nowadays, patients undergoing liver transplantation are more likely to be older with cardiac comorbidities. There is limited data about major adverse cardiovascular events (MACE) (myocardial infarction, heart failure (HF), arrhythmias, stroke, pulmonary embolism) and outcome in patients with decreased cardiac contractility presenting for liver transplantation. We present cardiovascular outcomes in a case series of five patients with LVEF<55% who underwent liver transplantation.
Methods: Following institutional review board approval, we reviewed liver and combined liver-kidney transplant casesin patients ≥18 years old performed from January 2016 to December 2018 at University of Miami/Jackson Memorial Hospital. Out of 287 records,five patients met the inclusion criteria of LV EF< 55% pretransplant. Perioperative data wasobtained by retrospective review of electronic medical records.
Results: Patients with EF<55% were all elderly (age 63-76). MACE (MI/stroke/heart failure/arrhythmia) was noted in 4 out of 5 patients (Table 1). Postoperative atrial fibrillation occurred in two patients while heart failure occurred in 3 out of 5 patients. HF was due to ischemic (2) and nonischemic (1) causes. Two out of three patients with preoperative CAD >50% had ischemic heart failure postoperatively. One patient had a severe decrease in EF (15%), which showed no improvement even three months after surgery. Intraoperatively, he had severe reperfusion syndrome and hepatic artery thrombosis, and post operatively, he developed stress induced cardiomyopathy and had a long hospital stay. Despite MACE, there was no mortality or graft failure 1 year postoperatively. All patients had low MELD, short operative time, and minimal blood transfusion (PRBC 3-8 units).None of the patients had pre transplant hospitalization.
Conclusion: Patients with preoperative decrease cardiac function (EF<55%) are more likely to be elderly with preoperative ischemic disease. These patients are at higher risk of MACE postoperatively.Careful cardiovascular optimization, adequate patient selection, and favorable operative variables can lead to good postoperative outcome.