Evaluation of the right ventricular ejection fraction during classic orthotopic liver transplantation without venovenous bypass.
BACKGROUND
Right ventricular (RV) function is sensitive to changes in cardiac loading conditions, and RV dysfunction may contribute to hemodynamic instability during orthotopic liver transplantation (OLT). Thus, we evaluated RV function and its role in hemodynamic instability during classic OLT without venovenous bypass (VVB).


METHODS
Thirty patients undergoing classic OLT without VVB were studied. Right ventricular ejection fraction (RVEF) was measured using a modified pulmonary artery catheter. Hemodynamic data were recorded at pre-determined time points: T0, baseline; T1-T3: 5, 15, and 30 min after clamping; T4-T7: 5, 15, 30, and 120 min after reperfusion; T8 and T9: 24 and 48 h after surgery.


RESULTS
The baseline RVEF was lower than normal value. RVEF decreased significantly from T1 to T4 and returned to baseline beginning at T5. At 24 and 48 h after surgery, RVEF was higher than baseline value. RVEF was correlated with stroke volume index and post-reperfusion syndrome during OLT. Compared to the low MELDs group, RVEF in the high MELDs group was lower at T1, T2, and T4.


CONCLUSIONS
Right ventricular function was compromised during the anhepatic and early reperfusion stages in patients undergoing classic OLT without VVB, particularly in the high MELD score patients. Close monitoring of RV function in these patients should be considered.
Department of Anesthesiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Haitao
H
Xu
Weiwei
W
Li
Zhendong
Z
Xu
Xueyin
X
Shi
D000293:Adolescent; D000328:Adult; D058625:End Stage Liver Disease / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015424:Reperfusion; D013318:Stroke Volume; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000601:surgery*; D016278:Ventricular Function, Right; D055815:Young Adult