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Updated: Aug 30, 2026
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Assessment of ventricular contractile function during orthotopic liver transplantation
Claus G Krenn1, Rashid Hoda, Ajsa Nikolic
1Department of Anesthesiology, University Hospital of Vienna, 1090 Vienna, Austria. claus.krenn@univie.ac.at
Insights
Orthotopic liver transplantation (OLT) affects heart function, but myocardial dysfunction plays a minor role in hemodynamic instability. Volume fluctuations are the primary cause of instability during OLT.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Hemodynamic alterations are critical in orthotopic liver transplantation (OLT) outcomes.
- The contribution of myocardial dysfunction to OLT-related hemodynamic instability remains controversial.
- Previous transesophageal echocardiography (TEE) studies lack definitive conclusions due to unaccounted confounding factors.
Purpose of the Study:
- To investigate the role of myocardial contractility in hemodynamic instability during OLT.
- To assess left ventricular shortening fraction (LVSF) changes during different phases of OLT.
Main Methods:
- Measured left ventricular shortening fraction (LVSF) in 10 OLT patients without veno-venous bypass.
- Assessed LVSF during preparation (PP), anhepatic (AP), and reperfusion (RP) phases.
- Utilized echocardiography to evaluate myocardial contractility.
Main Results:
- A significant decrease in LVSF was observed during the anhepatic phase (AP).
- LVSF levels remained above subnormal ranges in most patients during AP.
- LVSF returned to baseline preparation phase (PP) values during the reperfusion phase (RP).
Conclusions:
- Orthotopic liver transplantation (OLT) influences myocardial function.
- Myocardial dysfunction plays a minor role in OLT-induced hemodynamic instability.
- Volume fluctuations are the primary contributors to hemodynamic instability during OLT.
Abstract:
Hemodynamic alterations are a well-known phenomenon that influence the outcome of orthotopic liver transplantation (OLT). Whether or not myocardial dysfunction, which has various causes, contributes to this instability is still debated. Previous transesophageal echocardiography (TEE) studies have presented controversial data, not leading to final clarification. This is mainly because the impact of other contributing factors (inotropic support, alternating preload conditions and temperature) remained unaccounted for. We therefore measured the left ventricular shortening fraction (LVSF), a parameter reflecting myocardial contractility, in 10 consecutive patients undergoing OLT without veno-venous bypass. We measured during preparation (PP), during the anhepatic (AP) phase and the immediate reperfusion phase (RP). During the AP we observed a significant decrease of LVSF which never fell to subnormal levels in the majority of our patients, whereas during the RP, LVSF returned to PP values. These findings support the assumption that myocardial function is influenced by OLT, but that it plays only a minor role in the occurrence of hemodynamic instability, which could mainly be attributed to volume fluctuations.
