Incidence and significance of abnormal hepatic venous Doppler flow velocities before cardiac surgery.
OBJECTIVE
The purpose of this study was to determine the incidence and significance of abnormal hepatic Doppler venous flow velocities as signs of an abnormal right ventricular filling pattern before cardiac surgery.


METHODS
Retrospective and prospective validation study.


METHODS
Tertiary care hospital.


METHODS
Cardiac surgical patients (121 patients).


METHODS
Not applicable.


METHODS
Demographic, hemodynamic, and echocardiographic variables; vasoactive support; and difficult separation from bypass were compared between patients with or without abnormal hepatic venous Doppler flow. Logistic regression analysis was performed to identify predictors of difficult separation from bypass. Abnormal hepatic venous flow was observed in 23 (29%) and 17 patients (41%) in the retrospective and prospective study. Abnormal hepatic venous flow before surgery was associated with more vasoactive support in both the retrospective (p = 0.0362) and prospective study (p = 0.0163). In the prospective study, abnormal hepatic venous flow was associated with a higher Parsonnet score (p = 0.0005), more atrial fibrillation (p < 0.0001), pacemaker requirement (p = 0.0124), mitral valve replacement (p = 0.0325), reoperation (p = 0.0050), lower mean arterial pressure to pulmonary artery pressure ratio (p = 0.0127), higher wall motion score index (p = 0.0491), and higher incidence of abnormal right ventricular systolic function (p = 0.0139). Abnormal hepatic venous flow was not found to be an independent predictor of difficult separation from bypass.


CONCLUSIONS
Abnormal hepatic venous flow velocities before cardiac surgery are frequent and are associated with increased need for vasoactive support after cardiopulmonary bypass. However, it is not an independent predictor of difficult separation from bypass and worse outcome.
Carricart
Maïté
M
Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
Denault
André Y
AY
Couture
Pierre
P
Limoges
Patrick
P
Babin
Denis
D
Levesque
Sylvie
S
Fortier
Annik
A
Pellerin
Michel
M
Tardif
Jean-Claude
JC
Buithieu
Jean
J
D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008102:Liver Circulation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D016276:Ventricular Function; D016277:Ventricular Function, Left / Q000502:physiology