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Liver transplantation without venovenous bypass: morbidity and mortality in patients with greater than 50% reduction in cardiac output after vena cava clamping.

Abstract：

OBJECTIVE:To investigate whether a decrease in cardiac output of >or=50% after vena cava clamping is associated with an increase in perioperative morbidity or mortality in patients undergoing orthotopic liver transplantation without venovenous bypass. DESIGN:Retrospective, clinical study. PARTICIPANTS:Patients undergoing elective orthotopic liver transplantation without venovenous bypass (n = 172). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:In 82 patients (group 1), the decrease in cardiac output after vena cava clamping was >or=50%; in 90 patients (group 2), the decrease was <50%. Hemodynamics during surgery and perioperative morbidity and mortality were compared between group 1 and group 2 patients. Mean arterial pressure during the anhepatic phase was not significantly different between groups, but cardiac output and mixed venous oxygen saturation were significantly lower in group 1 patients. Perioperative mortality, need for postoperative renal replacement therapy, postoperative serum creatinine levels, and graft function were not different between groups. CONCLUSION:A >50% reduction in cardiac output after vena cava clamping is not associated with an increase in perioperative morbidity and mortality when compared with patients with a less pronounced reduction in cardiac output. These results question the common practice of basing the indication for venovenous bypass during the anhepatic phase on a reduction in cardiac output of >50% after a trial of vena cava clamping.

journal_name

J Cardiothorac Vasc Anesth

journal_title

Journal of cardiothoracic and vascular anesthesia

authors

Schwarz B,Pomaroli A,Hoermann C,Margreiter R,Mair P

doi

10.1053/jcan.2001.24982

keywords:

subject

Has Abstract

pub_date

2001-08-01 00:00:00

pages

460-2

issue

4

eissn

1053-0770

issn

1532-8422

pii

S1053-0770(01)31203-X

journal_volume

15

pub_type

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