Liver Transplant; Complications Clinical Trial
Official title:
Intraoperative Evaluation of Right Ventricular Function During Liver Transplantation: a Quantitative Analysis Using Transesophageal Echocardiography
Cirrhotic patients undergoing liver transplantation might develop acute transient right ventricular dysfunction, ranging from mild to severe form. More than two decades ago, a number of studies with pulmonary artery catheters looked at this particular issue with controversial results. However, the pulmonary artery catheter as a monitor for right ventricular function (RVF) has several limitations, while the echocardiogram is deemed to be more accurate in this regard. Therefore, we sought to evaluate the RVF with the transesophageal echocardiogram, and particularly whether the RVF significantly varies during this procedure.
Evaluation of right ventricular function (RVF) during orthotopic liver transplantation (OLT)
has been extensively reported with modified pulmonary artery catheters that measure the right
ventricular ejection fraction. However, quantitative analysis of RVF using transesophageal
echocardiography (TEE) are scarce in this setting.
Methods: Nineteen cirrhotic patients who underwent OLT from April-2012 to April-2013 will be
studied. Analysis of echocardiogram-derived parameters routinely used to evaluate ventricular
function will be done. In particular, the RVF was quantitatively assessed by two parameters
derived from TEE: tricuspid annular plane systolic excursion (TAPSE) and right ventricular
fractional area change (RVFAC). Exclusion criteria: pulmonary hypertension, fulminant
hepatitis, age less than 18 or greater than 65 years old and cardiopulmonary diseases. All
echocardiographic and hemodynamic data set have been collected at 5 stages during the
procedure, according to Institutional Protocol: baseline, hepatectomy, anhepatic phase,
post-reperfusion, and closure.
Statistical Analysis: One-way ANOVA for repeated measurements will be used if the data have
normal distribution, otherwise Friedman test will be used. P<0.05 is to be considered
significant.
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