A retrospective case-control study of intraoperative cardiac dysfunction in elderly patients (≥60 years) undergoing...

The age range of patients accepted for the orthotopic liver transplantation (OLT) has widened. Concerns have arisen, therefore, about the ability of the hearts of elderly patients to manage these stressful conditions. The aim of this study was to investigate the preoperative echocardiographic findings and the intraoperative cardiac dysfunction among elderly cirrhotic recipients undergoing live donor OLT.

In this retrospective case-control study we evaluated clinical data, echocardiography, and intraoperative right-sided heart hemodynamic measurements from 2007 and 2009 among 56 recipients aged at least 60 years who were matched for gender and the severity of cirrhosis. Intraoperative cardiac dysfunction was defined as a decreased left ventricular stroke work index despite an increase in right ventricular end diastolic volume index (RVEDVI) or pulmonary artery occlusion pressure (PAOP). We compared measurements at predetermined times during the anhepatic and neohepatic periods with those at baseline.

Older recipients (mean, 63 years; range, 60-69) showed significantly reduced early diastolic annular velocity (E'), early maximal ventricular filling velocity (E)/late filling velocity (A) ratio, and increased A on echocardiography versus younger recipients (mean 48 years; range, 31-56). We observed negative correlation between age and E' (r = -0.44; P < .001) and a positive correlation between age and E/E' (r = 0.31; P < .01). The incidence of intraoperative cardiac dysfunction did not differ between case and control groups with an increase of RVEDVI (11.4% vs 10.6%) or PAOP (27.2% vs 25.0%) during the anhepatic and neohepatic periods. A higher proportion of older recipients needed inotropic agents during OLT (60.7% vs 39.3%; P = .04).

OLT patients of ar least 60 years of age may not show a greater incidence of cardiac dysfunction during OLT versus younger ones, although older recipients showed reduced diastolic function and more frequently required inotropic support.