The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation

Abstract

Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases at a tertiary care academic medical center. We collected intraoperative variables of baseline central venous pressure, baseline right ventricle end-diastolic volume, mixed venous oxygen saturation, intraoperative PVR and right and left ventricular stroke work indexes. Time-weighted means or area under the curve of intraoperative right and left ventricular stroke work indexes were calculated as exposure variables. One-year all-cause mortality or graft failure was our primary outcome. Cox proportional hazard regression analysis was performed to evaluate the association between exposure variables and one-year all-cause mortality or graft failure. Kaplan–Meier survival curve analysis of our primary outcome was performed for different time-weighted mean ventricular stroke work index groups. Cubic spline curve analysis was performed to evaluate the linear relationship between our exposure variables and primary outcome. Time-weighted mean right ventricular stroke work index was significantly associated with one-year all-cause mortality or graft failure (hazard ratio 1.21, 95% confidence interval (CI) 1.12–1.36, p < 0.001). However, there was no significant association between time-weighted mean left ventricular stroke work index, time-weighted mean PVR, PVR at the end of surgery and one-year mortality. Area under the curve of right ventricular stroke work index was also significantly associated with one-year mortality or graft failure (hazard ratio 1.24, 95% CI 1.15–1.37, p < 0.001). Kaplan–Meier survival curve analysis showed a significant difference in the survival between different mean right ventricular stroke work index groups (Log-rank test: p = 0.002). Cubic spline function curve showed the gradual increase in the risk of mortality with a positive slope with time-weighted mean right ventricular stroke work index. In conclusion, intraoperative elevated right ventricular stroke work index was significantly associated with poor patient or graft survival after liver transplantation. Intraoperative right ventricular stroke work index could be an intraoperative hemodynamic goal and prognostic marker for mortality after liver transplantation.

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

“…The authors highlighted that the RV function plays a crucial role in maintaining stable hemodynamics and close monitoring of the RV function is essential [ 34 ]. Moreover, a study has shown that right heart-associated hemodynamic factors were associated with patient survival after liver transplantation or graft failure [ 35 ]. Even though no association between the time-weighted LV stroke work index and PVR for one-year mortality was demonstrated, the time-weighted mean RV stroke work index was found significantly related with one-year all-cause mortality.…”

“…Even though no association between the time-weighted LV stroke work index and PVR for one-year mortality was demonstrated, the time-weighted mean RV stroke work index was found significantly related with one-year all-cause mortality. The study advised that the intraoperative RV stroke work index might be a prognostic marker for mortality after liver transplantation [ 35 ]. In our study, patients treated with NSBBs had significantly less RV systolic dysfunction, which might be associated with good outcome in this population both during transplantation and follow-up.…”