Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation

Abstract

AIMTo assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant (OLT).METHODSA retrospective data analysis was performed and data (mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit (ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/mPAP ratio, 2 hemodynamic responses were identified: Group 1 (MAP/mPAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2 (MAP/mPAP ratio with no change during anhepatic period or decreased without recovery, n = 25).RESULTSThe main finding was that the lack of increased MAP/mPAP ratio in the anhepatic period was associated with: (1) longer intubation times; and (2) prolonged ICU stays and total hospitalization time, when compared to patients with an increase in MAP/mPAP ratio during the anhepatic period.CONCLUSIONThe data from this retrospective study should raise awareness to the mean systemic to pulmonary artery pressure ratio as a potential indicator for poor outcome after OLT. Further prospective studies are needed for validation.

Comparison Effect of Nebulized Milrinone and Intravenous Milrinone in Patients With Pulmonary Hypertension Who Candidate of Open-heart Surgery: a Double Blind Randomized Clinical Trial

“…In our study, the MAP/mPAP ratio as a predictor of the outcome of cardiac surgery was signi cantly lower in the IV group than in the nebulized milrinone group as same as previous study (5,19,20). If this ratio in the preoperative period is less than 4, it indicates a lower survival rate, more hemodynamic complications, and suggests prolong vasopressor support for more than 24 h or the use of intra-aortic balloon pump in patients with PH after cardiac surgery (19). The result of Ibrahim's study were consistent with our results.…”

Inhaled milrinone in cardiac surgical patients: a pilot randomized controlled trial of jet vs. mesh nebulization

“…The use of a relative hemodynamic parameter to evaluate the severity of PH such as the mAP/mPAP ratio (normal 4 to 1) has been shown to be much more predictive of outcome in various types of cardiac surgical procedures [37][38][39][40][41] . Induction of anesthesia reduces all pressures including mAP and mPAP, but the mAP/mPAP ratio remains unchanged 37 .…”

Postoperative right ventricular dysfunction—Integrating right heart profiles beyond long-axis function

“…11 Other components can be divided as consequences or mechanism of RV failure (Figure 1). Hemodynamic elements, such as central venous pressure and the mean pulmonary arterial pressure to systemic arterial pressure ratio (yielding insights into both the pulmonary and systemic circulations [13][14][15][16][17] ) are useful to monitor; however, combined pulmonary artery and RV pressure waveform (Figure 1, A) 18 appears to be a promising method for detecting abnormal RV function. 19 The current understanding of RV failure combines the ventricular and the arterial elastance as an index of RVarterial coupling.…”