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

Kim, Sung Hoon; Moon, Young‐Jin; Lee, Soo-Ho; Jeong, Seonghee; Song, Jae-Kwan; Hwang, Gyu‐Sam

doi:10.1002/lt.24415

Cited by 13 publications

(7 citation statements)

References 39 publications

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“…Cause of intraoperative bradycardia in LT is multifactorial [14][15][16] and identification of exact cause is beyond scope of this investigation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

Sun

et al. 2018

Clinical Transplantation

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Nonselective Beta blockade (NSBB) is commonly prescribed for liver transplantation (LT) candidates, but its impact on intraoperative hemodynamics is not well understood. In this study, we investigated if preoperative NSBB was associated with severe bradycardia during LT and if severe intraoperative bradycardia was associated with 30‐day mortality. Adult patients undergoing LT between 2005 and 2014 were included. Propensity matching was used to control selection bias. Intraoperative hemodynamics were compared between patients with and without preoperative NSBB. Univariate and multivariate methods were used in statistical analysis. Of 1452 patients, 370 who received preoperative NSBB were matched in a 1:1 ratio with those who did not. Propensity matching eliminated all significant differences between the two groups. Patients who received preoperative NSBB had a significantly higher incidence of severe intraoperative bradycardia compared with the non‐BB group (9.6% vs 3.2%, P = 0.001, OR 2.95, 95% CI 1.42‐6.12, P = 0.004). Intraoperative hypotension and postreperfusion syndrome were not significantly different between the two groups. Severe intraoperative bradycardia was associated with increased 30‐day mortality. In conclusion, preoperative NSBB was associated with severe intraoperative bradycardia in LT. In patients who receive preoperative NSBB, severe intraoperative bradycardia should be closely monitored in LT. Further studies assessing safety of preoperative NSBB and intraoperative bradycardia in LT are warranted.

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“…Cause of intraoperative bradycardia in LT is multifactorial [14][15][16] and identification of exact cause is beyond scope of this investigation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

Sun

et al. 2018

Clinical Transplantation

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“…The prospectively recorded hemodynamic and medical data of 74 consecutive liver transplantation (LT) surgeries performed from February 2018 to April 2018 in our institution were collected and analyzed in a retrospective fashion. The anesthetic management, perioperative patient care, and vital sign data recruitment for LT surgery were performed according to the standard institutional protocol of the Asan Medical Center, which has been previously described in detail [13,14,15,16]. In brief, anesthesia was induced with thiopental sodium, vecuronium, and fentanyl.…”

Section: Methodsmentioning

confidence: 99%

Deep Learning-Based Stroke Volume Estimation Outperforms Conventional Arterial Contour Method in Patients with Hemodynamic Instability

Moon

Moon²,

Kim³

et al. 2019

JCM

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Although the stroke volume (SV) estimation by arterial blood pressure has been widely used in clinical practice, its accuracy is questionable, especially during periods of hemodynamic instability. We aimed to create novel SV estimating model based on deep-learning (DL) method. A convolutional neural network was applied to estimate SV from arterial blood pressure waveform data recorded from liver transplantation (LT) surgeries. The model was trained using a gold standard referential SV measured via pulmonary artery thermodilution method. Merging a gold standard SV and corresponding 10.24 seconds of arterial blood pressure waveform as an input/output data set with 2-senconds of sliding overlap, 484,384 data sets from 34 LT surgeries were used for training and validation of DL model. The performance of DL model was evaluated by correlation and concordance analyses in another 491,353 data sets from 31 LT surgeries. We also evaluated the performance of pre-existing commercialized model (EV1000), and the performance results of DL model and EV1000 were compared. The DL model provided an acceptable performance throughout the surgery (r = 0.813, concordance rate = 74.15%). During the reperfusion phase, where the most severe hemodynamic instability occurred, DL model showed superior correlation (0.861; 95% Confidence Interval, (CI), 0.855–0.866 vs. 0.570; 95% CI, 0.556–0.584, P < 0.001) and higher concordance rate (90.6% vs. 75.8%) over EV1000. In conclusion, the DL-based model was superior for estimating intraoperative SV and thus might guide physicians to precise intraoperative hemodynamic management. Moreover, the DL model seems to be particularly promising because it outperformed EV1000 in circumstance of rapid hemodynamic changes where physicians need most help.

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“…All patients received standardized anesthetic care according to the protocols of our institution, as previously described [8,9,10,11]. Anesthesia was induced with propofol, midazolam, fentanyl, and rocuronium.…”

Section: Methodsmentioning

confidence: 99%

Quantitative Analysis of an Intraoperative Digitalized Esophageal Heart Sound Signal to Speculate on Perturbed Cardiovascular Function

Moon

Kim

Park

et al. 2019

JCM

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Although visualization of heart sounds, known as phonocardiography, provides valuable information on cardiovascular hemodynamics, its use has not been widely encouraged due to the scarcity of information on its interpretation. In the present study, using the intraoperative phonocardiogram recorded by an esophageal stethoscope, we quantitatively evaluated the time and frequency domains of modulation of the heart sounds components and their association with left ventricular contractility and systemic vascular resistance under the effects of various cardiovascular drugs. We analyzed 29 pairs of intraoperative digitalized phonocardiographic signals and their corresponding hemodynamic data before and after cardiovascular drug administration (ephedrine, esmolol, phenylephrine, and/or nicardipine) in 17 patients who underwent liver transplantation. The S1 and S2 components of the heart sounds (the first and second heart sounds, respectively) were identified and their modulation in time and frequency domains was analyzed. As an index of cardiovascular function, systolic tissue Doppler wave velocity (TDI S’), maximal dP/dt from the arterial waveform, and systemic vascular resistance were simultaneously evaluated. Ephedrine/esmolol and phenylephrine/nicardipine primarily affected the S1 and S2 components of the heart sounds, respectively. This result implies that the intraoperative phonocardiogram may have the potential to be useful in detecting the changes in contractility and afterload that commonly occur in patients receiving anesthesia. In an era of constant need for noninvasive hemodynamic assessment, phonocardiography has the potential for use as a novel and informative tool for monitoring of hemodynamic function.

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

Cited by 13 publications

References 39 publications

Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

Preoperative beta blockade and severe intraoperative bradycardia in liver transplantation

Deep Learning-Based Stroke Volume Estimation Outperforms Conventional Arterial Contour Method in Patients with Hemodynamic Instability

Quantitative Analysis of an Intraoperative Digitalized Esophageal Heart Sound Signal to Speculate on Perturbed Cardiovascular Function

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