TRANSCAVAL LIVER RESECTION WITH HEPATOATRIAL ANASTOMOSIS FOR TREATMENT OF PATIENTS WITH THE BUDD-CHIARI SYNDROME - LATE RESULTS

Between 1980 and 1990 transcaval liver resection with hepatoatrial ana stomosis was performed in 17 patients with the Budd-Chiari syndrome. T here were two early deaths (early mortality 11.7%). Hepatic function r eturned to normal and hepatosplenomegaly disappeared in all but two pa tients with preexisting cirrhosis. All survivors regained normal worki ng capacity after the operation. During an average follow-up of 6 year s (7 months to 11 years) there were three late deaths due to progressi on of the underlying disease. The actuarial 1-, 5-, and 10-year surviv als were 82%, 76%, and 57%, respectively. Hepatoatrial anastomosis rep resents an optimal treatment for patients with the Budd-Chiari syndrom e and obstruction of major hepatic veins. Patients with compression of the inferior vena cava, very common in this disease, were treated by simultaneous transcaval stenting. The late results are very satisfacto ry, with excellent quality of life. With adequate hepatic function, re sults of hepatoatrial anastomosis are superior to those of liver trans plantation, which represents the only alternative for patients with th e advanced form of the Budd-Chiari syndrome.