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Right ventricular function during orthotopic liver transplantation

A M De Wolf1, B Begliomini, T A Gasior

  • 1Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pennsylvania.

Anesthesia and Analgesia
|March 1, 1993
PubMed
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Right ventricular (RV) function remains preserved during orthotopic liver transplantation. This study found RV ejection fraction (EFrv) was consistently supranormal, indicating RV function is not significantly impaired by the procedure.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Critical Care Medicine

Background:

  • Orthotopic liver transplantation (OLT) is associated with frequent hemodynamic instability.
  • The role of right ventricular (RV) function in this instability requires further elucidation.
  • Assessing RV function is crucial for managing patients undergoing OLT.

Purpose of the Study:

  • To assess right ventricular (RV) function in patients undergoing orthotopic liver transplantation (OLT).
  • To determine the impact of OLT on RV ejection fraction (EFrv) and related hemodynamic parameters.
  • To evaluate the clinical utility of right atrial pressure (Pra) as an indicator of RV preload during OLT.

Main Methods:

  • Twenty patients undergoing OLT were studied.

Related Experiment Videos

  • A modified pulmonary artery catheter with a thermistor was used to measure RV ejection fraction (EFrv).
  • Hemodynamic measurements, including RV end-diastolic volume index (EDVIrv) and stroke index (SI), were taken at three stages: dissection, anhepatic, and neohepatic.

    • Main Results:

    • Right ventricular (RV) function was well-preserved throughout OLT, with supranormal RV ejection fraction (EFrv) observed.
    • A slight, clinically insignificant decrease in EFrv occurred during the anhepatic stage.
    • Right atrial pressure (Pra) did not correlate with EDVIrv, suggesting it is an unreliable indicator of RV preload.

    Conclusions:

    • Orthotopic liver transplantation (OLT) itself does not appear to cause significant right ventricular (RV) dysfunction.
    • RV function remains robust during OLT when using venovenous bypass, even with hemodynamic challenges.
    • Right atrial pressure (Pra) is not a reliable clinical indicator of RV preload in this context.