Right Ventricular Function During Orthotopic Liver Transplantation

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Abstract
Right ventricular (RV) function was assessed in 20 patients undergoing orthotopic liver transplantation to determine its role in the hemodynamic instability frequently seen during this procedure. A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RV ejection fraction (EFrv) allowing for calculation of RV end-diastolic volume index (EDVIrv as the ratio of stroke index [SI] to EFrv) and RV end-systolic volume index (ESVIrv as the difference between EDVIrv and SI). The above hemodynamic measures were taken during dissection for hepatectomy (stage I), during the anhepatic stage (stage II), and after reperfusion of the grafted liver, the neohepatic stage (stage III). No patient had pulmonary hypertension during the study interval. No correlation was observed between right atrial pressure (Pra and EDVIrv indicating that Prv, is a less reliable clinical in dicator of RV preload. RV function appeared to be well preserved throughout the procedure, as indicated by a relatively constant and supranormal EFrv although a small and probably clinically unimportant decrease in EFrv, was observed during the anhepatic stage (0.52, 0.50, and 0.55 during stages I, II, and III, respectively). There was a strong correlation between SI and EDVIrv, for pooled data over a wide range of EDVIrv, (60--185 mL·m−2). Although unstable central blood temperature precluded the determination of EFrv, within the first 5 min after reperfusion, RV function was unaltered otherwise during uncomplicated orthotopic liver transplantation using venovenous bypass, indicating that orthotopic liver transplantation per se is not associated with significant RV dysfunction.

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