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Ann Thorac Surg 2004;78:e30-e33
© 2004 The Society of Thoracic Surgeons

Case report

Open-heart surgery in pediatric patients with end-stage liver disease

Emile A. Bacha, MD*a, Joel Hardin, MDb,e, David C. Cronin, MD, PhDc, Lynda Brady, MDd, Michael J. Millis, MDc, Joanne P. Starr, MDa, Peter Koenig, MDb, Suanne Daves, MDe, Madelyn Kahana, MDe

a Cardiothoracic Surgery, Pediatric and Congenital Cardiac Surgery, Chicago, IL, USA
b Section of Pediatric Cardiology, The University of Chicago Children's Hospital, Chicago, IL, USA
c Section of Transplantation Surgery, The University of Chicago Children's Hospital, Chicago, IL, USA
d Section of Pediatric Hepatology, The University of Chicago Children's Hospital, Chicago, IL, USA
e Section of Pediatric Critical Care, The University of Chicago Children's Hospital, Chicago, Illinois, USA

Accepted for publication November 25, 2003.

* Address reprint requests to Dr Bacha, Pediatric and Congenital Cardiac Surgery, The University of Chicago Children's Hospital, 5841 S Maryland Ave, Chicago, IL 60637, USA.
e-mail: ebacha{at}surgery.bsd.uchicago.edu

Little is known about the safety of pediatric cardiac surgery in children with end-stage liver disease. We reviewed our experience with 4 patients with biliary atresia or Alagille's syndrome who underwent repair of ventricular septal defect and tricuspid regurgitation, atrioventricular canal, subaortic stenosis, or supravalvular aortic stenosis. One patient died on postoperative day 2. All other patients survived to discharge. At follow-up, 1 patient died at home awaiting liver transplantation and the remaining patients are doing well. One patient received a successful liver transplant. Pediatric cardiac surgery in children with end-stage liver disease can be done safely, albeit with a higher mortality.




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