Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis

Abstract

Background Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy. Methods In this systematic review and meta-analysis, randomised controlled trials (RCTs) were searched in the Cochrane Library, Medline, Embase, and Web of Science to February 02, 2023. RCTs focused on cardiovascular interventions aimed at reducing blood loss or blood transfusion requirements during hepatectomy were included. The primary outcomes were perioperative blood loss amount, number of patients requiring allogeneic blood transfusion and overall occurrence of postoperative complications. The secondary outcomes were operating time, perioperative mortality rate, postoperative liver and kidney function and length of hospital stay. Results Seventeen RCTs were included in the analysis. A total of 841 patients who underwent hepatectomy in 10 trials were included in the comparative analysis between low central venous pressure (CVP) and control groups. The forest plots showed a low operative bleeding volume [(mean difference (MD): -409.75 mL, 95% confidence intervals (CI) -616.56 to -202.94, P < 0.001], reduced blood transfusion rate [risk ratio (RR): 0.47, 95% CI 0.34 to 0.65, P < 0.001], shortened operating time (MD: -13.42 min, 95% CI -22.59 to -4.26, P = 0.004), and fewer postoperative complications (RR: 0.76, 95% CI 0.58 to 0.99, P = 0.04) in the low CVP group than in the control group. Five and two trials compared the following interventions, respectively: ‘acute normovolaemic haemodilution (ANH) vs control’ and ‘autologous blood donation vs control’. ANH and autologous blood donation could not reduce the blood loss amount but greatly decreased the number of patients requiring allogeneic blood transfusion. No benefits were found in the rate of mortality and length of postoperative hospital stay in any of the comparisons. Conclusion Lowering the CVP seems to be effective and safe in adult patients undergoing hepatectomy. ANH and autologous blood donation should be used as a part of blood management for suitable patients in certain circumstances. Trial registration PROSPERO, CRD42022314061.

Safe and Effective Blood Preservation Through Acute Normovolemic Hemodilution and Low-Dose Tranexamic Acid in Open Partial Hepatectomy

“…14,15 ANH, either alone or in conjunction with a low CVP strategy, significantly decreased the need for allogeneic blood transfusions during hepatectomy. 16,17 We specifically found that when TXA was combined with ANH, the median blood loss was 700 mL (13.3 mL/kg), a substantial reduction compared to the 1200 mL (20.4 mL/kg) observed in the ANH-only group, with statistical significance (P < 0.05). While two out of the 15 patients in the TXA and ANH group required blood transfusions and plasma infusions during the operation, this figure was lower than the 4 patients in the ANH-only group, although this difference did not reach statistical significance (P > 0.05), likely due to the small sample size.…”

Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

“…The central venous catheter (CVC) is a standard of care for liver transplantation [1 && ,29,105]. A recent review of literature showed that low central venous pressure (LCVP) decreases surgical bleeding and improves postoperative outcomes in hepatectomies including in pediatrics [10,56]. The threshold for LCVP is traditionally less than 5 mmHg; however, a recent study showed that a LCVP of less than 8 mmHg is equally beneficial and more practical to reach and correlates with a stroke volume variation (SVV) more than 13% [55].…”