Inclusion and exclusion criteria for combined cardiac surgery and liver transplantation at Cleveland Clinic
| Inclusion criteria Severe or complex coronary artery or valve disease not amenable to percutaneous intervention |
| Contraindication to dual antiplatelet therapy such as need for repeated paracentesis or a noncardiac intervention, or chronic thrombocytopenia |
| Child-Pugh score > 8, needing cardiac surgery for cardiovascular optimization but otherwise a candidate for liver transplantation |
| Patients with a very high Model for End-stage Liver Disease score who cannot wait to complete at least 3 months of dual antiplatelet therapy after a percutaneous intervention before proceeding with liver transplantation |
| Left ventricular ejection fraction > 55% |
| Exclusion criteria Left ventricular dysfunction |
| Advanced chronic kidney disease |
| Unsuitable coronary anatomy |
| Active infection |
| Extrahepatic malignancy |
| Other contraindications to liver transplantation itself, such as evidence of substance abuse, history of nonadherence, and poor social resources |