Effects of Cardiac Valve Dysfunction on Perioperative Management of Liver Transplantation
Effects of Cardiac Valve Dysfunction on Perioperative Management of Liver Transplantation
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DOI：
10.1016/j.transproceed.2009.02.089
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发表时间：
2009-06-01
影响因子：
0.9
通讯作者：
Kilic, M.
中科院分区：
文献类型：
--
作者：
Alper, I.;Ulukaya, S.;Kilic, M.
Objective.我们的目的是通过回顾性队列研究，探讨心脏瓣膜功能障碍对原位肝移植（奥尔特）围手术期管理的影响。346例患者在奥尔特前接受了超声心动图（ECHO）检查。将瓣膜功能障碍患者的数据与ECHO正常的受试者进行比较。我们评估了患者的特征、手术变量、血流动力学过程、血液制品、液体和药物需求、拔管和死亡率。95例（27.5%）心脏瓣膜功能障碍患者被分类为二尖瓣关闭不全（MVI; n = 32）、三尖瓣关闭不全（TVI; n = 23）或MVI和TVI（n = 40）。152例患者显示正常的ECHO检查（对照）。99名患有其他疾病的患者被排除在研究之外。与对照组相比，MVI组的全身血管阻力显著降低，MVI组以及MVI和TVI组的心输出量（CO）显著升高。与对照组相比，更多的MVI患者以及MVI和TVI患者需要肾上腺素。MVI组需要输血的患者数量高于对照组（P <0.05）。患者特征、终末期肝功能衰竭评分、手术持续时间、血流动力学变量、再灌注后综合征的发生率、麻黄碱和肾上腺素的平均剂量、红细胞、新鲜冷冻血浆和液体需求、术后立即拔管的患者数量和死亡率在两组之间没有差异。我们的研究表明，心脏瓣膜功能障碍可能与接受奥尔特的患者中的终末期肝病有关。MVI或MVI和TVI患者需要更多的围手术期护理。
Objective. Our aim was to investigate the effects of cardiac valve dysfunction on perioperative management of orthotopic liver transplantation (OLT) among a retrospective cohort.Patients and Methods. Three hundred forty-six patients underwent echocardiographic (ECHO) examination prior to OLT. Data of patients with valvular dysfunctions were compared to subjects with normal ECHO. We evaluated patient characteristics, operation variables, hemodynamic course, blood products, fluid and drug requirements, extubation, and mortality rates.Results. Ninety-five patients (27.5%) with cardiac valve dysfunction were classified as mitral valve insufficiency (MVI; n = 32), tricuspid valve insufficiency (TVI; n = 23), or both MVI and TVI (n = 40). One hundred fifty-two patients displayed normal ECHO examinations (control). Ninety-nine patients with other pathologies were excluded from the study. Systemic vascular resistance was significantly lower among the MVI group, and cardiac output (CO) significantly higher in the MVI and both MVI and TVI groups compared with controls. More MVI and both MVI and TVI patients required epinephrine compared with controls. The number of patients who required blood transfusion was higher in the MVI than the control group (P < .05). Patient characteristics, end-stage liver failure scores, duration of operations, hemodynamic variables, incidence of postreperfusion syndrome, mean doses of ephedrine and epinephrine, red blood cells, fresh frozen plasma and fluid requirements, number of patients extubated immediately after surgery, and mortality rates were not different between the groups.Conclusions. Our study demonstrated that cardiac valve dysfunction may be associated with end-stage liver disease among patients undergoing OLT. Patients with MVI or both MVI and TVI required more care in perioperative management.