• Wei Kelly Wu, Kara K Siegrist, Ioannis A Ziogas, Kelly L Mishra, Lea K Matsuoka, Jonathan N Menachem, Manhal Izzy, Alexandra Shingina, Nhue L Do, Matthew Bacchetta, Ashish S Shah, and Sophoclis P Alexopoulos.
• Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN; Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN.
• J. Cardiothorac. Vasc. Anesth. 2024 Mar 1; 38 (3): 745754745-754.

ObjectivesCombined heart-liver transplantation (CHLT) is becoming increasingly frequent as a maturing population of patients with Fontan-palliated congenital heart disease develop advanced liver fibrosis or cirrhosis. The authors present their experience with CHLT for congenital and noncongenital indications, and identify characteristics associated with poor outcomes that may guide intervention in high-risk patients.DesignThis was a single-center retrospective cohort study.SettingThis study was conducted at Vanderbilt University Medical Center in Nashville, Tennessee.ParticipantsThe study included 16 consecutive adult recipients of CHLT at the authors' institution between April 2017 and February 2022.InterventionsEleven patients underwent transplantation for Fontan indications, and 5 were transplanted for non-Fontan indications.Measurements And Main ResultsCompared with non-Fontan patients, Fontan recipients had longer cardiopulmonary bypass duration (199 v 119 minutes, p =m0.002), operative times (786 v 599 minutes, p = 0.01), and larger blood product transfusions (15.4 v 6.3 L, p = 0.18). Six of 16 patients required extracorporeal membrane oxygenation (ECMO), of whom 4 were Fontan patients who subsequently died. Patients who required ECMO had lower 5-hour lactate clearance (0.0 v 3.5 mmol/L, p = 0.001), higher number of vasoactive infusions, lower pulmonary artery pulsatility indices (0.58 v 1.77, p = 0.03), and higher peak inspiratory pressures (28.0 v 18.5 mmHg, p = 0.01) after liver reperfusion.ConclusionsCombined heart-liver transplantation in patients with Fontan-associated end-organ disease is particularly challenging and associated with higher recipient morbidity compared with non-Fontan-related CHLT. Early hemodynamic intervention for signs of ventricular dysfunction may improve outcomes in this growing high-risk population.Copyright © 2023. Published by Elsevier Inc.

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