Right ventricular end-diastolic volume index as a predictor of preload status in patients with low right ventricular ejection fraction during orthotopic liver transplantation.
OBJECTIVE
The objective of this study was to compare the accuracy of 2 variables: pulmonary artery occlusion pressure (PAOP) and right ventricular end diastolic volume index (RVEDVI) as predictors of the hemodynamic response to fluid challenge as well as definition of the overall correlation between RVEDVI and change in PAOP, right ventricular ejection fraction (RVEF), central venous pressure (CVP), and determination of the right ventricular function during orthotopic liver transplantation.


METHODS
A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RVEF, allowing calculation of RVEF end-diastolic volume index (EDVI, as the ratio of stroke index [SI] to EF). The above-mentioned hemodynamic measures were taken in 4 phases: T0, after induction of anesthesia; T1, during anhepatic phase; T2, 30' after graft reperfusion; and T3, at the end of surgery.


RESULTS
The variation of the REF value was 36 +/- 4% and 39 +/- 6%. Linear regression analysis showed a significant correlation between RVEDVI (range, 133 +/- 33-145 +/- 40 mL/m(2)) and stroke volume index (SVI) in each phase (r(2) = 0.49, P < .01; r(2) = 0.57, P < .01) at T0 and T1, respectively, and at T2 and T3 (r(2) = 0.51, P < .01; r(2) = 0.44, P < .01), respectively. No significant variations in the linear regression analysis between RVEDVI, PAOP, CVP, and RVEF were observed. No relationship was found between PAOP (range, 10 +/- 2-6 +/- 2 mm Hg) and SVI.


CONCLUSIONS
RVEDVI may be the best clinical estimate of right ventricular preload. In fact, minor changes of RVEF have been recorded, confirming that RV function was not altered during uncomplicated orthotopic liver transplantation.
Siniscalchi
A
A
Division of Anesthesiology, University of Bologna, Bologna, Italy. sinianest@libero.it
Pavesi
M
M
Piraccini
E
E
De Pietri
L
L
Braglia
V
V
Di Benedetto
F
F
Lauro
A
A
Spedicato
S
S
Dante
A
A
Pinna
A D
AD
Faenza
S
S
D000328:Adult; D003971:Diastole; D005260:Female; D006339:Heart Rate; D006352:Heart Ventricles / Q000033:anatomy & histology; D006439:Hemodynamics; D006526:Hepatitis C / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011237:Predictive Value of Tests; D018497:Ventricular Dysfunction, Right / Q000150:complications*; D016278:Ventricular Function, Right