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World Journal of Surgery
Published in: World Journal of Surgery 4/2014

01-04-2014

Stroke Volume Response to Liver Graft Reperfusion Stress in Cirrhotic Patients

Authors: Bibiana Escobar, Pilar Taurá, Graciela Martínez-Palli, Constatino Fondevila, Jaume Balust, Joan Beltrán, Javier Fernández, Juan Carlos García-Pagán, Juan Carlos García-Valdecasas

Published in: World Journal of Surgery | Issue 4/2014

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Abstract

Introduction

In patients with advanced cirrhosis, stressful stimuli may reveal a silent reduced cardiac performance. During liver transplantation (LT), graft reperfusion strongly stresses the heart and may unmask latent myocardial dysfunction.

Aim

The objective of this study was to assess heart response to acutely increased preload after liver graft reperfusion and correlate this response with preoperative data and outcome.

Methods

Preoperative clinical, echocardiographic, and hemodynamic data, and patient outcome were retrospectively recorded for 235 liver recipients who had no known cardiac disease. Myocardial dysfunction was defined as less than 10 % increase of stroke volume after graft reperfusion (non-responder).

Results

We found 84 (35.7 %) non-responder patients. The non-responders showed higher Model for end-stage liver disease scores (p = 0.046), left atrial diameter (LAD) (p = 0.040), hepatic vein pressure gradient (p = 0.055), and hyperdynamic state than responders. The percentages of patients with hyponatremia (p = 0.048) and alcohol etiology (p = 0.025) were also higher among non-responders. Independent predictors of inadequate cardiac response in the multivariate analysis were low preoperative systemic vascular resistance (SVRI) [odds ratio (OR) 3.09, 95 % CI 1.15–4.82; p = 0.027] and enlargement of LAD (OR 2.08, 95 % CI 1.49–2.74; p = 0.044). Non-response was associated with higher rates of early cardiovascular events [hazard ratio (HR) 2.84, 95 % CI 1.09–4.22; p = 0.039] and higher length of intensive care unit stay (p = 0.038). No differences were found in 1-year survival rates.

Conclusions

Latent cardiac dysfunction among LT recipients, considered to be abnormal stroke volume response to unclamping of portal vein, is very prevalent. SVRI and LAD were independent predictors of inadequate responses. This condition deserves special attention since it may aggravate the early postoperative course of LT.
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Metadata
Title
Stroke Volume Response to Liver Graft Reperfusion Stress in Cirrhotic Patients
Authors
Bibiana Escobar
Pilar Taurá
Graciela Martínez-Palli
Constatino Fondevila
Jaume Balust
Joan Beltrán
Javier Fernández
Juan Carlos García-Pagán
Juan Carlos García-Valdecasas
Publication date
01-04-2014
Publisher
Springer US
Published in
World Journal of Surgery / Issue 4/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2289-x

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