Hepatic blood flow and right ventricular function during cardiac surgery assessed by transesophageal echocardiography

Gårdebäck, M; Settergren, G.; La, Brodin

doi:10.1016/s1053-0770(96)80090-5

Cited by 32 publications

(21 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3] Despite marked improvement in cardiopulmonary bypass (CPB) strategies, post-operative hyperbilirubinaemia remains a serious concern, correlating with worse post-operative outcomes. 1,6,7 Most studies were concerned with identifying factors predicting the incidence of post-operative jaundice, following cardiac surgery. 1,6,7 Most studies were concerned with identifying factors predicting the incidence of post-operative jaundice, following cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Whether this form of liver dysfunction is an effect of CPB associated factors, that is, haemolysis, hypoperfusion, or systemic inflammatory response, remains to be asserted. 1,6,7 Most studies were concerned with identifying factors predicting the incidence of post-operative jaundice, following cardiac surgery. While transient moderate hyperbilirubinaemia is usually associated with a favourable outcome, late occurring ascending hyperbilirubinaemia was associated with higher mortality and morbidity.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hyperbilirubinaemia after cardiac surgery: the point of no return

et al. 2019

View full text Add to dashboard Cite

Aims The occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post‐operative heart failure is fairly common. We investigated the incidence, predictive value, and post‐operative outcome of hyperbilirubinaemia after cardiac surgery in an effort to identify potential risk factors and significance on clinical outcome. Methods and results Between 2006 and 2016, 1272 (10.1%) out of 12 556 patients developed hyperbilirubinaemia, defined as bilirubin concentration >3 mg/dL, during post‐operative course at our institution. All patients who were operated using cardiopulmonary bypass were included. Hepatic dysfunction was diagnosed preoperatively in 200 patients (15.7%), whereas mean model of end‐stage liver disease score was 11.22 ± 4.99. Early mortality was 17.4% with age [hazard ratio (HR) 1.019, 95% confidence interval (CI) 1.008–1.029; P = 0.001], diabetes (HR 1.115, CI 1.020–1.220; P = 0.017), and emergent procedures (HR 1.315, CI 1.012–1.710) as multivariate predictors. Post‐operative predictors were low‐output syndrome (HR 3.193, 95% CI 2.495–4.086; P < 0.001), blood transfusion (HR 1.0, CI 1.0–1.0; P < 0.001), and time to peak bilirubin (HR 1.1, CI 1.0–1.1; P < 0.001). We found an increased correlation with mortality at 3.5 post‐operative day as well as an optimal cut‐off value for bilirubin of 5.35 mg/dL. A maximum bilirubin of 25.5 mg/dL was associated with 99% mortality. Survival analysis showed significantly decreased survival for patients who developed late, rather than early, hyperbilirubinaemia. Conclusions Post‐operative hyperbilirubinaemia is a prevalent threat after cardiopulmonary bypass, associated with high early mortality. The timing and amount of peak bilirubin concentration are linked to the underlying pathology and are predictors of post‐operative outcome. Patients with late development of steep hyperbilirubinaemia warrant meticulous post‐operative care optimizing cardiac and end organ functions before reaching the point of no return.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperbilirubinaemia after cardiac surgery: the point of no return

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Even with the current perioperative management and surgical techniques, the prevalence of perioperative hyperbilirubinemia is still as high as 25-40% [7][8][9]. The systemic inflammatory response [10], hepatic hypoperfusion [11], hemolysis [12] caused by CPB, and perioperative blood transfusion [10] may disrupt the bilirubin metabolism and lead to hyperbilirubinemia.…”

Section: Introductionmentioning

confidence: 99%

Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury

Liao

Song

et al. 2019

Nephron

View full text Add to dashboard Cite

Aims: Hyperbilirubinemia is associated with postoperative acute kidney injury in patients undergoing cardiac surgeries. A high concentration of bilirubin could induce oxidative stress and cell apoptosis. The aim of this study was to investigate whether hyperbilirubinemia aggravated the renal tubule cells injury and the pro-apoptotic potential of bilirubin on renal ischemia reperfusion injury (RIRI). Methods: The human proximal tubular epithelial cell line HK-2 cells were challenged with a gradient concentration of bilirubin for 24 h. Cell injury was assessed by flow cytometry and MTT assay. Bilirubin was injected intraperitoneally into male Sprague-Dawley rats once every 12 h (100 mg/kg), 3 times in total. The same solvent volume without bilirubin powder was used as vehicle in non-bilirubin injection groups. The RIRI surgical procedure was a bilateral renal pedicles clamping (45 min) followed by 30 h reperfusion. The rats were divided into 4 groups: negative control (NC), similar surgical procedures without clamping; Bil, bilirubin injection for 36 h, then rats were sacrificed; RIRI, RIRI surgical procedures; Bil + RIRI, RIRI applied 6 h later than the first bilirubin injection, rats were sacrificed after another 30 h. Results: In vitro, bilirubin induced cell apoptosis and significantly decreased the cell viability of HK-2 cells. Bilirubin induced the active caspase 3 and phosphorylation of p38 in HK-2 cells. In vivo, serum creatinine was higher in Bil + RIRI compared with RIRI (p < 0.01). The tubular injury scores of hematoxylin and eosin and tubular necrosis scores of periodic acid-Schiff were higher in Bil + RIRI than these in RIRI (All p < 0.05). The number of Tunel-positive nuclei was higher in Bil + RIRI compared to RIRI (p < 0.001). The active caspase 3 and phosphorylation of p38 were higher and the Bcl2 was lower in Bil + RIRI compared to RIRI. Moreover, the apoptosis level was higher in Bil compared to NC. Conclusions: Our results reveal that the hyperbilirubinemia induces pro-apoptotic effects and aggravates RIRI.

show abstract

“…Meierhenrich et al [11], on the other hand, studied 34 patients scheduled for abdominal surgery and using multiplane TEE, they successfully identified the three main hepatic veins in all patients. Indeed, a number of studies support the proposition that TEE can provide good visualizations of both the IVC and RHV [12][13][14].…”

Section: Discussionmentioning

confidence: 92%

Could transesophageal echocardiography be useful in selected cases during liver surgery resection?

et al. 2014

View full text Add to dashboard Cite

Purpose Although only limited scientific evidence exists promoting the use of transesophageal echocardiography (TEE) in non cardiac surgery, several recent studies have documented its usefulness during liver surgery. Methods and resultsIn the present case study, through the use of color Doppler TEE, compression of the inferior vena cava and the right hepatic vein was clearly evident, as was their restoration after surgery. Conclusion TEE should be encouraged in patients undergoing liver resection, not only for hemodynamic monitoring, but also for its ability to provide information about the anatomy of the liver, its vessels, and inferior vena cava patency.Keywords Transesophageal echocardiography Á Liver surgery Á Hepatic angioma Á Hemodynamic monitoring Riassunto Il fegato può essere coinvolto da una varietà di patologie, che vanno dalle lesioni benigne come l'angioma epatico, che possono necessitare di essere resecate, all'insufficienza epatica per la quale l'unica terapia possible è il trapianto di fegato. Benchè ci siano solo limitate evidenze scientifiche che supportino l'utilizzo dell'ecografia transesofagea (TEE) nella chirurgia non cardiaca, alcuni studi hanno documentato la sua utilità durante la chirurgia epatica. Nel caso in studio, attraverso l'uso del color Doppler TEE la compressione della vena cava inferiore a della vena epatica destra erano visualizzate così come le loro dimensioni dopo l'intervento chirurgico. Per tale motivo l'utilizzo del TEE dovrebbe essere incoraggiato nei pazienti che vanno incontro a resezione epatica non solo come strumento di valuatzione emodinamica ma anche per la sua abilità di dare informazioni utili sull'anatomia del fegato dei suoi vasi e sulla pervietà della vena cava.

show abstract

Hepatic blood flow and right ventricular function during cardiac surgery assessed by transesophageal echocardiography

Cited by 32 publications

References 16 publications

Hyperbilirubinaemia after cardiac surgery: the point of no return

Hyperbilirubinaemia after cardiac surgery: the point of no return

Hyperbilirubinemia Induces Pro-Apoptotic Effects and Aggravates Renal Ischemia Reperfusion Injury

Could transesophageal echocardiography be useful in selected cases during liver surgery resection?

Contact Info

Product

Resources

About