The evolution of diastolic function during liver transplantation.

Area of Science:

• Cardiology
• Transplantation Medicine
• Critical Care Medicine

Background:

• Liver transplantation is prone to cardiocirculatory complications.
• Diastolic dysfunction may contribute to these complications.
• Transesophageal echocardiography (TEE) is used to assess cardiac function during liver transplantation.

Purpose of the Study:

• To evaluate peroperative changes in diastolic function during liver transplantation.
• To identify predictors of diastolic dysfunction and associated complications.

Main Methods:

• Prospective analysis of TEE recordings in 40 liver transplant patients.
• Measurement of lateral mitral annular early diastolic velocity (E') using tissue-Doppler imaging.
• Assessment of left ventricular filling pressures and systolic function.

Main Results:

• No global change in E' velocity, but 27.5% of patients showed a decrease indicative of diastolic dysfunction.
• Patients with decreased E' had lower preoperative E' values and higher rates of postoperative cardiorespiratory complications.
• Diastolic dysfunction (E' < 10 cm/s) at unclamping was not associated with complications.

Conclusions:

• Diastolic dysfunction frequently occurs during liver transplantation.
• Peroperative diastolic dysfunction may be linked to postoperative cardiorespiratory complications.
• Systematic echocardiographic evaluation of diastolic function is valuable in liver transplant management.