Effects of dobutamine on right ventricular function and pulmonary circulation in pulmonary hypertension during liver transplantation.
BACKGROUND
In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment.


METHODS
To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 microg/kg/min) to maintain a cardiac index (CI) >3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, CI, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated.


RESULTS
RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased.


CONCLUSIONS
Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.
Acosta
F
F
Liver Transplantation Unit, University Hospital V. Arrixaca, Murcia, Spain. franciscoj.acosta@carm.es
Sansano
T
T
Palenciano
C G
CG
Falcon
L
L
Domenech
P
P
Robles
R
R
Bueno
F S
FS
Ramirez
P
P
Parrilla
P
P
D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000188:drug therapy*; D007430:Intraoperative Care; D016031:Liver Transplantation / Q000379:methods*; D009200:Myocardial Contraction / Q000187:drug effects; D011652:Pulmonary Circulation / Q000187:drug effects*; D016278:Ventricular Function, Right / Q000187:drug effects*
D002316:Cardiotonic Agents; D004280:Dobutamine