Rescue of Reperfusion-Related Cardiac Collapse by Balloon Flotation Pacing During Liver Transplantation: A Case Report

Reperfusion-related cardiac collapse is a life-threatening, rare event in liver transplantation (LT). Here, we report the successful use of balloon flotation pacing to prevent cardiac collapse in a 66-year-old man who underwent LT for acute-on-chronic liver failure. The patient’s model for end-stage liver disease score was 26. He had left coronary artery stent placement a year ago. After general anesthesia, a balloon flotation pacing catheter was positioned. Orthotopic piggyback style LT was performed using total inferior vena cava clamping. Before reperfusion, the pacemaker was turned on in VVI mode. Twenty seconds after unclamping, the heart rate slowed down abruptly, and the blood pressure fell to 38/30 mmHg from 123/75 mmHg. The pacemaker triggered, maintaining a heartbeat of 83 per minute. Repeated bolus of epinephrine (700 μg total) and calcium gluconate (3 g total) were administered. The situation lasted for 6 minutes. The supraventricular rhythm resumed, and the patient stabilized hemodynamically. He was extubated after 28 hours and discharged home after a 22-day hospital stay. This case confirms that balloon flotation pacing is a feasible method for preventing reperfusion-related cardiac collapse during LT.