June 10, 1998
University of Illinois at Chicago
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Carol Mattar
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A year ago, 59-year-old Anthony Capua underwent a double liver transplant-coronary bypass through a pioneering procedure at the University of Illinois at Chicago. Capua is living a normal life and enjoying his retirement. Done separately, either operation probably would have failed and he would not have survived. After doctors at two Chicago hospitals told him it was impossible to perform the two procedures simultaneously, two University of Illinois at Chicago physicians operated successfully on June 19, 1997. The La Grange, Ill., resident had been on a waiting list for two months before a suitable liver became available. Surgeon Malek Massad did the bypass first. Then, with Capua's heart once again functioning normally, his colleague Enrico Benedetti replaced his damaged liver.
Only two successful simultaneous coronary artery bypass graftings and orthotopic liver transplantations have been reported in medical literature. But Benedetti believes there will be more as older people at risk for coronary artery disease are evaluated for transplants.
"Forty percent of liver transplants are done on people above 50," he said. "Consequently, more of those people are likely to have coronary artery disease. If you do the transplant without fixing the heart, the patient will die of a heart attack. But you can't fix the heart because of the severe liver failure."
Advanced coronary artery disease has traditionally been considered an absolute contraindication to liver transplantation, the surgeons wrote in a paper about the procedure in the April 1998 Annals of Thoracic Surgery. Chronic liver failure significantly increases the risk for coronary artery bypass surgery, they added.
"The presence of advanced coronary artery disease in a candidate for liver transplantation should not be considered an absolute contraindication to transplant," they said. "In selected cases, performing a simultaneous coronary artery bypass and liver transplantation may provide an ideal treatment for both life-threatening diseases."
Considering Capua's active life a year after the surgery, "the outcome has proven we were right," Benedetti said.
The surgical team plans to perform the same procedure on two more patients at UIC as soon as donor livers become available.
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