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

Abstract

Background: The right ventricular end-diastolic volume index (RVEDVI) is a good indicator of preload in patients undergoing liver transplantation. Although dynamic indices, such as stroke volume variation (SVV), have been used as reliable indicators in predicting fluid responsiveness, the evaluation of the relationship between SVV and direct preload status is limited. We investigated the relationship between SVV and RVEDVI, and tested the cutoff value of SVV to predict RVEDVI during liver transplantation.Methods: A total of 150 data pairs in 30 living donor liver transplant recipients were retrospectively investigated. Hemodynamic parameters, including SVV and RVEDVI were obtained from each patient at the 5 specific time points. Linear regression and receiver operating characteristic (ROC) curve analyses were performed.Results: The SVV significantly correlated with the RVEDVI (r = -0.616, P < 0.001). Cutoff values for the upper and lower tertiles of RVEDVI were 157 mL/m2 and 128 mL/m2, respectively. Tertile analysis indicated that upper tertile of RVEDVI had a significantly lower SVV than the middle tertile (median; 5% vs 8%, P < 0.05), and middle tertile of RVEDVI had a significantly lower SVV than the lower tertile (median; 8% vs 11%, P < 0.05). A 6% cutoff value of SVV estimated the upper tertile RVEDVI (>157 mL/m2) with the area under the curve of ROC curve of 0.832. A 9% cutoff value of SVV estimated the lower tertile RVEDVI (<128 mL/m2) with the area under the curve of ROC curve of 0.792.Conclusion: SVV may be a valuable estimator of RVEDVI in patients undergoing liver transplantation.

Relationship between Stroke Volume Variation and Blood Transfusion during Liver Transplantation

“…Liver transplantation procedures were performed by a dedicated team using the standard anesthesia protocol of Asan Medical Center. 12 - 14 After applying routine hemodynamic monitoring, general anesthesia was induced with thiopental, fentanyl, and vecuronium. Following endotracheal intubation, anesthesia was maintained using sevoflurane, a 50% O 2 /air mixture, vecuronium, and fentanyl.…”

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

“…As for the graft preservative solution, histidine tryptophan ketoglutarate solutions were used in all patients. The anesthetic management, patient care, and hemodynamic data recruitment for LT surgery were performed according to the standard institutional protocol of Asan Medical Center, which was previously described in detail . Briefly, anesthesia was induced with thiopental sodium, fentanyl, and vecuronium.…”

“…The anesthetic management, patient care, and hemodynamic data recruitment for LT surgery were performed according to the standard institutional protocol of Asan Medical Center, which was previously described in detail. (9)(10)(11)(12)(13) Briefly, anesthesia was induced with thiopental sodium, fentanyl, and vecuronium. After endotracheal intubation, anesthesia was maintained with isoflurane or sevoflurane in a 50% air/oxygen mixture and continuous infusion of fentanyl and vecuronium.…”

Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation

“…Cases with incomplete recording of hemodynamic data were also excluded. In all cases, general anesthesia was performed according to the standardized protocol of our institution [16][17][18][19], as follow;…”