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Hepatic circulation during nonpulsatile cardiopulmonary bypass
1Department of Cardiovascular Surgery, Kyoto University Faculty of Medicine, Japan.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|July 1, 1995
Summary
Portal venous flow (PVF) remains stable during nonpulsatile cardiopulmonary bypass (CPB), suggesting hepatic hypoperfusion may not be the primary cause of reduced arterial ketone body ratios. This study monitored PVF using Doppler ultrasonography in 24 patients undergoing CPB.
Area of Science:
- Cardiovascular Surgery
- Hepatology
- Medical Imaging
Background:
- Arterial ketone body ratio reduction during cardiopulmonary bypass (CPB) indicates altered hepatic mitochondrial redox potential (NAD+/NADH).
- Hepatic hypoperfusion is a potential cause for this reduction in arterial ketone body ratio during CPB.
Purpose of the Study:
- To evaluate hepatic circulation during nonpulsatile CPB.
- To assess portal venous flow (PVF) in adult patients undergoing CPB.
Main Methods:
- Color Doppler ultrasonography was used to measure PVF in 24 adult patients.
- Measurements were taken before, during (aortic clamping and rewarming), and after CPB.
- Nonpulsatile hypothermic CPB was conducted at a flow rate of 2.4 L/min/m2.
Main Results:
- PVF was maintained during CPB at 0.44 ± 0.13 L/min/m2 and 0.54 ± 0.18 L/min/m2.
- PVF as a percentage of systemic blood flow (PVF/CI or PVF/PI) was 18.3 ± 9.3% before, 18.5 ± 5.5% during, and 17.4 ± 6.7% after CPB.
- PVF was dependent on systemic blood flow during nonpulsatile CPB.
Conclusions:
- Portal venous flow is adequately maintained during nonpulsatile CPB at a flow rate of 2.4 L/min/m2.
- Hepatic hypoperfusion might not be the sole reason for arterial ketone body ratio decrease during CPB.
- Systemic blood flow is a key determinant of PVF during nonpulsatile CPB.