Open cardiotomy for removal of migrating transjugular intrahepatic portosystemic shunt stent combined with liver transplantation

Background. Transjugular intrahepatic shunts are widely used for the manage ment of variceal bleeding. Complications such as stent misplacement or migr ation may occur. Methods. We describe the management of a transjugular intrahepatic shunts s tent that migrated across the tricuspid valve in a patient with Child-Pugh category C cirrhosis. Results. An attempt at percutaneous retrieval of the stent was unsuccessful . Due to the unacceptably high risk for mortality from open heart surgery w ith cardiopulmonary bypass in the setting of cirrhosis, stent removal was d eferred until the time of orthotopic liver transplantation. The procedures were performed successfully, and the patient made a good recovery. Conclusion. Surgical stent extraction and valve repair can be performed saf ely along with orthotopic liver transplantation in carefully selected patie nts with end-stage liver disease.