Background: Historically, severe symptomatic aortic stenosis (AS) has been corrected surgically with aortic valve replacement. In patients with end stage liver disease (ESLD), cardiac surgery and liver transplantation (LT), performed sequentially or simultaneously have been associated with a high rate of morbidity and mortality. Thus, most patients with valvular heart disease have been excluded from LT. Aims: Transcatheter Aortic Valve Replacement (TAVR) has emerged as an alternative to high-risk cardiac surgery in patients with severe symptomatic AS. We examine the role of TAVR for severe AS in patients being considered for LT. Methods: We retrospectively reviewed the records of all patients with ESLD and severe symptomatic AS who underwent TAVR between 10/2011 and 09/2015. Patients underwent TAVR using the Edwards (Sapien, Sapien XT or S3) or Medtronic (CoreValve or Evolut) valves. The severity of liver disease was calculated using model for end stage liver disease (MELD). Results: Eight patients underwent TAVR for severe AS or severe AS with aortic insufficiency. Mean age was 60.62 + 6.25 years. There were 2 women and 6 men. MELD scores ranged from 10-21 with a mean of 13.5 + 3.59. The mean post-procedure length of hospital stay was 2.62 + 0.84 days. Procedural success was achieved in all cases. There were no life-threatening or bleeding complications and no hepatic decompensation. One patient developed LBBB post procedure, but did not require pacemaker insertion. A second patient developed a moderate perivalvular leak a month after TAVR insertion which was subsequently closed with a vascular plug. All patients had follow up, with median follow up of 16.5 months (range 2-49 months). Two patients underwent successful LT at 2 and 3 months after TAVR insertion. Three patients remain stable at 3, 38 and 49 months after TAVR insertion with current MELD scores of 17, 12 and 10, respectively. There were 3 late deaths at 16, 17 and 32 months of follow up (2 unknown causes and 1 with metastatic HCC). Conclusion: This is the first report of successful LT in patients who have undergone TAVR for severe AS. The procedure is effective and safe in patients with ESLD. However, outcomes in patients with more advanced liver disease (MELD score >21) warrant further study.

CITATION INFORMATION: Syed R, Cox-Alomar P, Bohorquez H, Therapondos G, Girgrah N, Joshi S, Tyson G, Reichman T, Carmody I, Loss G, Cohen A, Bruce D, Ahmed E, Seal J, Parrino P, Ramee S, Bzowej N. Transcatheter Aortic Valve Replacement (TAVR) for Severe Aortic Stenosis as a Bridge to Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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