title: Should temporary extracorporeal continuous portal diversion replace meso/porta-caval shunts in "small-for-size" syndrome in porcine hepatectomy?
abstract: OBJECTIVE
  To investigate the feasibility of temporary extracorporeal continuous porta-caval diversion (ECPD) to relieve portal hyperperfusion in "small-for-size" syndrome following massive hepatectomy in pigs.
  
  
  METHODS
  Fourteen pigs underwent 85%-90% liver resection and were then randomly divided into the control group (n = 7) and diversion group (n = 7). In the diversion group, portal venous blood was aspirated through the portal catheter and into a tube connected to a centrifugal pump. After filtration, the blood was returned to the pig through a double-lumen catheter inserted into the internal jugular or subclavian vein. With the conversion pump, portal venous inflow was partially diverted to the inferior vena cava through a catheter inserted via the gastroduodenal vein at 100-130 mL/min. Portal hemodynamics, injury, and regeneration in the liver remnant were compared between the two groups.
  
  
  RESULTS
  Compared to the control group, porta-caval diversion via ECPD significantly mitigated excessive portal venous flow and portal vein pressure (PVP); the portal vein flow (PVF), hepatic artery flow (HAF), and PVP in the two groups were not significantly different at baseline; however, the PVF (431.8 ± 36.6 vs 238.8 ± 29.3, P < 0.01; 210.3 ± 23.4 vs 122.3 ± 20.6, P < 0.01) and PVP (13.8 ± 2.6 vs 8.7 ± 1.4, P < 0.01; 15.6 ± 2.1 vs 10.1 ± 1.3, P < 0.05) in the control group were significantly higher than those in the diversion group, respectively. The HAF in the control group was significantly lower than that in the diversion group at 2 h and 48 h post hepatectomy, and ECPD significantly attenuated injury to the sinusoidal lining and hepatocytes, increased the regeneration index of the liver remnant, and relieved damage that the liver remnant suffered due to endotoxin and bacterial translocation.
  
  
  CONCLUSIONS
  ECPD, which can dynamically modulate portal inflow, can reduce injury to the liver remnant and facilitate liver regeneration, and therefore should replace permanent meso/porta-caval shunts in "small-for-size" syndrome.
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Da-Dong
authors.initials: DD
authors.lastname: Wang
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Zi-Man
authors.initials: ZM
authors.lastname: Zhu
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Xiang-Long
authors.initials: XL
authors.lastname: Tan
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Yu-Liang
authors.initials: YL
authors.lastname: Tu
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Ming-Ming
authors.initials: MM
authors.lastname: Han
authors.affiliation: Da-Dong Wang, Yong Xu, Zi-Man Zhu, Xiang-Long Tan, Yu-Liang Tu, Ming-Ming Han, Jing-Wang Tan, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
authors.forename: Jing-Wang
authors.initials: JW
authors.lastname: Tan
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D004195:Disease Models, Animal; D005112:Extracorporeal Circulation / Q000379:methods*; D005240:Feasibility Studies; D006439:Hemodynamics; D006498:Hepatectomy; D008102:Liver Circulation; D008115:Liver Regeneration; D016031:Liver Transplantation; D008297:Male; D008833:Microcirculation; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects*; D017082:Portal Pressure; D011169:Portal Vein / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013552:Swine; D013556:Swine, Miniature; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*
keywords: Extracorporeal continuous porta-caval diversion; Massive hepatectomy; Regeneration; Small-for-size syndrome