Abstract 4145296: Aortic Valve Hemodynamics in Liver Cirrhosis

Aortic valve stenosis (AS) is often a contraindication to liver transplantation (LT). Despite the widely accepted impact of liver cirrhosis on aortic valve hemodynamics, the change in these parameters with LT or impact of AS on LT outcomes has not been described. Given the rising burden of both AS and liver disease, there is an urgent need to understand this interaction. We identified 674 patients with liver cirrhosis who received LT at UCLA from 1/1/2013 to 12/31/2023 and investigated the change in echocardiographic hemodynamics within a year of the procedure. Patients with severe AS were excluded due to sparsity of these patients in the LT cohort. Aortic valve peak velocity (AV Vmax ) increased steadily as patients neared transplant and dropped significantly immediately after transplantation (Figure 1A). There was a larger magnitude of change in pre- to post-LT AV Vmax in patients with moderate (2.0 vs 1.6 m/s, p < 0.001) as compared to mild AS (1.5 vs 1.4 m/s, p < 0.001) in analysis of variance models. When patients were sorted by ascending pre-operative AV Vmax , the magnitude of fall in AV Vmax steadily increased (Figure 1B). There was a similar change in mean gradients whereas aortic valve area and dimensionless index remained unchanged after LT. There was a significant decrease in all other echocardiographic parameters associated with volume after LT: biatrial volume and pressure, and biventricular size. There was a 5.5% drop in left ventricular ejection fraction (LVEF) after LT that was statistically significant in confounder-controlled regression models (p<0.001) and negatively correlated with increasing preoperative AV Vmax (-6.2%/ms -1 , p = 0.02). The presence of mild or moderate aortic stenosis was not associated with a change in 30-day or 1-year mortality, need for intraoperative vasopressor or peri-operative blood products. Overall, our findings suggest that markers of volume and aortic transvalvular flow decrease after LT without significant change in aortic valve area. There is a significant post-operative fall in LVEF, the magnitude of which is proportional to pre-operative AV Vmax . Mild or moderate pre-operative AS are not associated with worse mortality or need for perioperative support.