Background: Patients with end stage liver disease may have coexisting cardiac disease which requires surgical correction which is associated with high morbidity and mortality unless the liver is replaced. It is unclear whether the cardiac surgery should be performed at the time or following liver transplantation, if at all possible.

Methods: Between February 1987 and December 2011, 12 patients (2 female, 10 male) underwent simultaneous cardiac operations and liver transplantation (Group A), 5 patients (2 female, 3 male) underwent cardiac operations after liver transplantation (Group B) at Miami Transplant Institute, University of Miami. The cardiac surgery in Group A includes heart transplantation (6), aortic valve replacement (3), coronary artery bypass grafting (2), and tricuspid and pulmonary valve replacement (1). Patients in Group B patients underwent cardiac surgery 2-138 months after liver transplantation, which includes heart transplantation (2), coronary artery bypass grafting (3).

Results: Survival rates at 6 months, 1 year, 2 years, 3 years, 5 years in group A and B are 75%, 58%, 42%, 42%, 42%, vs. 80%, 80%, 80%, 60%, 40% respectively (Kaplan-meier, p=0.02). Age, MELD score, gender, cumulative hospital stay did not differ between two groups.

Conclusions: Although long term outcome was similar in both groups, short term results were better when the liver transplant preceded the open heart surgery. Consequently, heart surgery should be postponed if at all possible.

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