Atrioventricular conduction disturbances immediately after hepatic graft reperfusion and their outcomes in patients undergoing liver transplantation

Abstract

Hemodynamic perturbation during hepatic graft reperfusion in patients undergoing liver transplantation (LT) is challenging and is frequently accompanied by bradyarrhythmia and even asystole. However, detailed data on electrocardiographic (ECG) changes during reperfusion are almost nonexistent, although the correct diagnosis by record is important for the treatment. We aimed to identify ECG rhythm disturbances during graft reperfusion and to investigate risk factors and outcomes. Data from 1065 consecutive patients who underwent adult LT were analyzed. The incidence, type, and detailed characteristics of ECG changes immediately after graft reperfusion were assessed using an electronically archived intraoperative ECG database. We analyzed risk factors, postoperative outcomes including major cardiovascular events, 30-day and 1-year mortalities of recipients based on the occurrence of atrioventricular (AV) block, and asystole during reperfusion. The typical pattern of postreperfusion bradyarrhythmia was progressive PR interval prolongation until a Mobitz type 1 AV block occurred. The overall incidence of AV block was 5.0% (53/1065), and 30.2% of them (16/53) had initiated as AV block and then progressed into ventricular asystole. Fulminant hepatic failure was a significant predictor for occurrence of AV block (odds ratio [OR], 7.20; 95% confidence interval, 3.38-15.32; P < 0.001). Patients with AV block showed significantly higher incidence of postoperative major cardiovascular events (P < 0.001) and 30-day mortality (P 5 0.002) than those without AV block, whereas the 1-year mortality was not different between the 2 groups (P 5 0.10). The postreperfusion asystole was consistently preceded by a Mobitz type 1 AV block. The occurrence of AV block and asystole appears to be an important prognosticator. Therefore, maintaining an optimal range of physiological status and gradual unclamping of the vena cava to avoid sudden atrial distension are recommended in high-risk patients during reperfusion period.Liver Transplantation 22 956-967 2016 AASLD.

Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

“…Cause of intraoperative bradycardia in LT is multifactorial [14][15][16] and identification of exact cause is beyond scope of this investigation.…”

Deep Learning-Based Stroke Volume Estimation Outperforms Conventional Arterial Contour Method in Patients with Hemodynamic Instability

“…The prospectively recorded hemodynamic and medical data of 74 consecutive liver transplantation (LT) surgeries performed from February 2018 to April 2018 in our institution were collected and analyzed in a retrospective fashion. The anesthetic management, perioperative patient care, and vital sign data recruitment for LT surgery were performed according to the standard institutional protocol of the Asan Medical Center, which has been previously described in detail [13,14,15,16]. In brief, anesthesia was induced with thiopental sodium, vecuronium, and fentanyl.…”

Quantitative Analysis of an Intraoperative Digitalized Esophageal Heart Sound Signal to Speculate on Perturbed Cardiovascular Function

“…All patients received standardized anesthetic care according to the protocols of our institution, as previously described [8,9,10,11]. Anesthesia was induced with propofol, midazolam, fentanyl, and rocuronium.…”