title: Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events.
abstract: OBJECTIVE
  The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies.
  
  
  METHODS
  Data were collected retrospectively from the electronic medical record and institutional echocardiography database.
  
  
  METHODS
  Single university hospital.
  
  
  METHODS
  A total of 100 patients undergoing OLT via total cavaplasty technique.
  
  
  METHODS
  Intraoperative TEE was performed in all 3 phases of OLT.
  
  
  RESULTS
  TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40%), isolated right ventricular dysfunction (n = 22, 22%), and intracardiac thromboemboli (n = 20, 20%).
  
  
  CONCLUSIONS
  Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events.
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE. Electronic address: sshillcu@unmc.edu.
authors: Sasha K
authors: SK
authors: Shillcutt
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
authors: Kyle J
authors: KJ
authors: Ringenberg
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
authors: M Megan
authors: MM
authors: Chacon
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
authors: Tara R
authors: TR
authors: Brakke
authors: Department of Anesthesiology, University of Utah Health Care, Salt Lake City, UT.
authors: Candice R
authors: CR
authors: Montzingo
authors: College of Public Health, University of Nebraska Medical Center, Omaha, NE.
authors: Elizabeth R
authors: ER
authors: Lyden
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
authors: Thomas E
authors: TE
authors: Schulte
authors: Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, NE.
authors: Thomas R
authors: TR
authors: Porter
authors: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
authors: Steven J
authors: SJ
authors: Lisco
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: adverse cardiac events; liver transplant; thrombus; transesophageal echocardiography