CASE REPORT article
Front. Surg.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1587370
This article is part of the Research TopicExploring New Frontiers in Heart Surgery: Case Studies 2025View all 6 articles
Dual Success: The Synergy of Off-Pump Coronary Artery Bypass and Living Donor Liver Transplantation -A Two-Case Report
Provisionally accepted
- 1Hacettepe University, Ankara, Ankara, Türkiye
- 2Demiroglu Bilim University, Istanbul, Türkiye
- 3Istanbul Florence Nightingale Hospital, Istanbul, Türkiye
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AbstractBackground: End-stage liver disease (ESLD) patients frequently exhibit comorbid coronary artery disease (CAD), complicating liver transplantation (LT) due to increased perioperative cardiovascular risk. In patients for whom percutaneous coronary intervention (PCI) is not feasible, coronary artery bypass grafting (CABG) may be required prior to or during LT. Off-pump CABG (OPCAB) presents a promising strategy to minimize the hemodynamic and inflammatory burdens associated with cardiopulmonary bypass, especially in ESLD patients undergoing major surgery.Case Presentations: We present two male patients (aged 60 and 61) with ESLD and significant LAD stenosis who underwent simultaneous OPCAB and living donor liver transplantation (LDLT). The first case involved cryptogenic cirrhosis and recurrent variceal bleeding; the second had HBV/HDV-related cirrhosis and hepatocellular carcinoma. In both cases, OPCAB was performed using the left internal mammary artery (LIMA) graft on a beating heart. Subsequently, LDLT was carried out using standard piggy-back techniques. Portal pressure modulation via splenic artery ligation was performed in the first case due to elevated post-reperfusion portal flow. Anesthetic management emphasized hemodynamic monitoring and stability. Both patients were extubated on postoperative day one, discharged with triple immunosuppression, and followed for 6–12 months with preserved cardiac and graft function. A bile leak from the cystic duct anastomosis was encountered in one case.Conclusion: Simultaneous OPCAB and LDLT is a feasible and safe approach in carefully selected ESLD patients with CAD when performed by experienced multidisciplinary teams. Avoiding PCI mitigates bleeding risks associated with dual antiplatelet therapy, while OPCAB circumvents the deleterious effects of cardiopulmonary bypass. This strategy may shorten transplant wait times and optimize both cardiac and hepatic outcomes in high-risk populations.
Keywords: end stage liver disease (ESLD), Coronary Artery Disease, Living donor liver transplant (LDLT), OPCAB (Off pump coronary artery bypass), Liver, Transplantation
Received: 04 Mar 2025; Accepted: 02 Jun 2025.
Copyright: © 2025 Yazıcı, ATASEVER, Cetinarslan, TURAN, SAGBAS and YUZER. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ahmet ATASEVER, Demiroglu Bilim University, Istanbul, 34394, Türkiye
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