title: Impact of mesocaval shunt on safe minimal liver remnant: porcine model.
abstract: OBJECTIVE
  To investigate the capacity of shunts to relieve portal hypertension and decrease the safe minimal liver remnant in pigs.
  
  
  METHODS
  A subtotal hepatectomy with < 60 mL blood loss and without hepatic pedicle occlusion was performed. The mesenteric venous inflow was diverted through a mesocaval shunt (MCS) constructed using the prepared left renal vein with an end-to-side running suture of 5-0 proline. All 21 animals that underwent subtotal hepatectomy and/or MCS were divided into three groups. In the 15% group, the residual volume was 14%-19% of total liver volume (TLV); in the 15%+ S group, the residual volume was also 14%-19% of TLV with a mesocaval shunt (MCS); and in the 10%+ S group, the residual volume was 8%-13% of TLV with an MCS. In the three groups, the intraoperative portal vein pressure (PVP) and portal vein flow (PVF) were monitored and compared at laparotomy and 1 h post-hepatectomy. The survival rate, sinusoidal endothelial damage, tissue analysis, and serum analysis were investigated among the three groups.
  
  
  RESULTS
  The percentage residual liver volume was 15.9%, 16.1% and 11.8% in the 15%, 15%+ S, 10%+ S groups, respectively. After hepatectomy, PVF and portal-to-arterial flow ratio in the 15%+ S group significantly decreased and hepatic artery flow (HAF) per unit volume significantly increased, compared to those in the 15% group. The PVP in the 15%+ S group and 10%+ S group increased slightly from that measured at laparotomy; however, in the 15% group, the PVP increased immediately and significantly above that observed in the other two groups. The 14-d survival rates were 28.5%, 85.6%, and 14.2% in the 15%, 15%+ S, and 10%+ S groups, respectively. In the 15%+ S group, the shunts effectively attenuated injury to the sinusoidal endothelium, and the changes in the serum and tissue analysis results were significantly reduced compared to those in the 15% and 10%+ S groups.
  
  
  CONCLUSIONS
  MCS can decompress the portal vein and so attenuate liver injury from hyperperfusion, and make extreme or marginal hepatectomy safer.
authors: Department of Hepatobiliary Surgery, the First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China.
authors: Yu-Liang
authors: YL
authors: Tu
authors: Xuan
authors: X
authors: Wang
authors: Da-Dong
authors: DD
authors: Wang
authors: Zi-Man
authors: ZM
authors: Zhu
authors: Jing-Wang
authors: JW
authors: Tan
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D003664:Decompression / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects*; D008099:Liver / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008102:Liver Circulation; D008297:Male; D008642:Mesenteric Veins / Q000503:physiopathology / Q000601:surgery*; D023421:Models, Animal; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control; D012082:Renal Veins / Q000637:transplantation*; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*
chemical_list: D015415:Biomarkers
keywords: Hepatectomy; Mesocaval shunt; Pigs; Safe minimal remnant volume
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