An experimental pilot study on controlled portal vein arterialization with an extracorporeal device in the swine model of partial liver resection and ischemia.
OBJECTIVE
To determine whether the physiologically oxygenated arterial blood reversed in the portal system by means of portal vein arterialization (PVA) through an extracorporeal device which we have called L.E.O2.NARDO (Liver Extracorporeal Oxygen. NARDO) is effective in treating swine with subtotal hepatectomy leading to acute liver failure (ALF).


METHODS
Ten swine with ALF induced by 85-90% liver resection and five minutes of ischemia-reperfusion injury were randomly divided into two groups: five animals received PVA extracorporeal treatment and five swine were not-treated (control group). Blood was withdrawn from the iliac artery and reversed in the portal venous system. An extracorporeal device was interposed between the outflow and the inflow in order to monitoring the hemodynamic parameters. Each treatment lasted 6 hours. Serum and liver samples were collected in both groups. The survival was assessed at 1 week.


RESULTS
The PVA-extracorporeal treatment yielded beneficial effects for subtotal hepatectomy-induced ALF swine with decreased serum ammonia, transaminases and total bilirubin as compared with the untreated group. INR recovered rapidly in the PVA-extracorporeal group remaining significantly lower than in untreated animals. The 7-day survival of PVA-extracorporeal group swine was significantly higher than that of untreated animals, with a statistically significant difference (p<0.05). Four swine in the PVA-extracorporeal group survived at 1 week while none of the swine in the control group were alive at that time; an average time of 144h+/-13h and 24.4h+/-5h was observed in the PVA-extracorporeal and control groups, respectively.


CONCLUSIONS
Arterial blood supply in the portal system through the extracorporeal device is easily applicable, efficacious, safe and may represent a novel approach for ALF swine induced by subtotal liver resection.
Nardo
B
B
Department of Surgery, Intensive Care Unit and Transplantations, S. Orsola Hospital, University of Bologna, Bologna - Italy. nardo@aosp.bo.it
Montalti
R
R
Puviani
L
L
Pacilè
V
V
Beltempo
P
P
Bertelli
R
R
Licursi
M
M
Pariali
M
M
Cianciavicchia
D
D
D000818:Animals; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D007511:Ischemia / Q000601:surgery; D008099:Liver / Q000098:blood supply; D008102:Liver Circulation; D017114:Liver Failure, Acute / Q000601:surgery*; D010865:Pilot Projects; D011169:Portal Vein; D013552:Swine