title: Incidence and significance of abnormal hepatic venous Doppler flow velocities before cardiac surgery.
abstract: 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.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Maïté
authors.initials: M
authors.lastname: Carricart
authors.forename: André Y
authors.initials: AY
authors.lastname: Denault
authors.forename: Pierre
authors.initials: P
authors.lastname: Couture
authors.forename: Patrick
authors.initials: P
authors.lastname: Limoges
authors.forename: Denis
authors.initials: D
authors.lastname: Babin
authors.forename: Sylvie
authors.initials: S
authors.lastname: Levesque
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.forename: Michel
authors.initials: M
authors.lastname: Pellerin
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Jean
authors.initials: J
authors.lastname: Buithieu
mesh_terms: 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