Continuous right ventricular end diastolic volume and right ventricular ejection fraction during liver transplantation: A multicenter study

Abstract

Cardiac preload is traditionally considered to be represented by its filling pressures, but more recently, estimations of end diastolic volume of the left or right ventricle have been shown to better reflect preload. One method of determining volumes is the evaluation of the continuous right ventricular end diastolic volume index (cRVEDVI) on the basis of the cardiac output thermodilution technique. Because preload and myocardial contractility are the main factors determining cardiac output during liver transplantation (LTx), accurate determination of preload is important. Thus, monitoring of cRVEDVI and cRVEF should help with fluid management and with the assessment of the need for inotropic and vasoactive agents. In this multicenter study, we looked for possible relationships between the stroke volume index (SVI) and cRVEDVI, cRVEF, and filling pressures at 4 predefined steps in 244 patients undergoing LTx. Univariate and multivariate autoregression models (across phases of the surgical procedure) were fitted to assess the possible association between SVI and cRVEDVI, pulmonary artery occlusion pressure (PAOP), and central venous pressure (CVP) after adjustment for cRVEF (categorized as Յ30, 31-40, and Ͼ40%). SVI was strongly associated with both cRVEDVI and cRVEF. The model showing the best fit to the data was that including cRVEDVI. Even after adjustment for cRVEF, there was a statistically significant (P Ͻ 0.05) relationship between SVI and cRVEDVI with a regression coefficient (slope of the regression line) of 0.25; this meant that an increase in cRVEDVI of 1 mL m Ϫ2 resulted in an increase in SVI of 0.25 mL m Ϫ2. The correlations between SVI and CVP and PAOP were less strong. We conclude that cRVEDVI reflected preload better than CVP and PAOP.

Inferior Vena Cava Distensibility as a Predictor of Fluid Responsiveness in Patients with Subarachnoid Hemorrhage

“…Central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) monitoring prove to have poor predictive value in differentiating patients who respond to intravascular volume load (responders) and patients who do not (non-responders) [11,12].…”

“…Static volumetric indicators such as global end-diastolic volume (GEDV), intrathoracic blood volume (ITBV) [11,13] and left ventricular end-diastolic area (LVEDA) [14] provide more reliable preload indexes than cardiac filling pressures.…”

Is Stroke Volume Variation a Useful Preload Index in Liver Transplant Recipients? A Retrospective Analysis

“…Although a possible disadvantage is that the thermodilutional technique can overestimate the preload status compared to 3-dimensional echocardiography or magnetic resonance imaging,13-15 the availabilities of latter two modalities are relatively limited in the operating theater. The assessment of right ventricle by magnetic resonance imaging is still a very difficult task due to its geometric complexity, and the echocardiographic transgastric view is unavailable during most of liver transplant procedure because of posterior retraction of the stomach 3. Furthermore, the RVEDVI is still regarded as the best clinical estimator of a right ventricular preload in patients undergoing liver transplantation,3,16,17 and its use during liver transplantation is encouraged 18,19.…”

“…The assessment of right ventricle by magnetic resonance imaging is still a very difficult task due to its geometric complexity, and the echocardiographic transgastric view is unavailable during most of liver transplant procedure because of posterior retraction of the stomach 3. Furthermore, the RVEDVI is still regarded as the best clinical estimator of a right ventricular preload in patients undergoing liver transplantation,3,16,17 and its use during liver transplantation is encouraged 18,19. In agreement with our previous studies,7-11 the RVEDVI obtained from patients undergoing liver transplantation in our present report typically showed a relatively high values (approximate average 140 mL/m 2 , range 76-264 mL/m 2 ), compared with healthy individuals (60-100 mL/m 2 ).…”

Perioperative Monitoring in Liver Transplant Patients

“…Advances in computation techniques have resulted in development of algorithms to calculate the global end-diastolic volume and the right ventricular end-diastolic (RVEDV) and end-systolic volumes, thereby facilitating better estimation of intravascular blood volume. 10 RVEDV is a valuable index of cardiac preload and is a more sensitive indicator of intravascular volume when compared with CVP and PAOP. 11,12 The PAC however, might be inaccurate if it is not positioned correctly and may not reflect changes in intravascular volume rapidly enough.…”