Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events

Shillcutt, Sasha K.; Ringenberg, Kyle J.; Chacon, M. Megan; Brakke, Tara R.; Montzingo, Candice R.; Lyden, Elizabeth; Schulte, Thomas E.; Porter, Thomas R.; Lisco, Steven J.

doi:10.1053/j.jvca.2015.09.009

Cited by 54 publications

(45 citation statements)

References 23 publications

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“…This study-striking incidence of 25% ICT/PE in MVTx is significantly higher than the reported range of 0.36-6.25% in patients undergoing OLT [9][10][11]. However, intraoperative cardiac thromboembolic events during OLT appear to be underreported, as a recent TEE study reported incidence of 27% [12]. Of note, no ICT/PE events were observed during isolated intestine, or modified MVTx in the current study.…”

Section: Discussioncontrasting

confidence: 69%

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

et al. 2018

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This study describes the risk of thrombotic and hemorrhagic complications, both intraoperatively, and up to 1 month following visceral transplantation. Data from 48 adult visceral transplants performed between 2010 and 2017 were retrospectively studied [32 multivisceral (MVTx); 10 isolated intestine; six modified-MVTx]. Intraoperatively, intracardiac thrombosis (ICT)/pulmonary embolism (PE) occurred in 25%, 0% and 0% of MVTx, isolated intestine and modified MVTx, respectively, and was associated with 50% (4/8) mortality. Preoperative portal vein thrombosis (PVT) was a significant risk factor for ICT/PE (P = 0.0073). Thromboelastography resembling disseminated intravascular coagulation (DIC) (r time <4 mm combined with fibrinolysis or flat-line) was statistically associated with occurrence of ICT/PE (P < 0.0001). Compared to subgroup without ICT/PE, occurrence of ICT/PE was associated with an increased demand for all blood product components both overall, and each surgical stage. Hyperfibrinolysis (56%) was identified as cause of bleeding in MVTx. Incidence of postoperative thrombotic event at 1 month was 25%, 30% and 17% for MVTx, isolated intestine and modified MVTx, respectively. Incidence of postoperative bleeding complications at 1 month was 11%, 20% and 17% for MVTx, isolated intestine and modified MVTx. In conclusion, MVTx recipients with preoperative PVT are at an increased risk of developing intraoperative life-threatening ICT/PE events associated with DIC-like coagulopathy.

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Section: Discussioncontrasting

confidence: 69%

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

et al. 2018

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“…In the literature, TEE has shown that more than 75% of patients exhibit some abnormal cardiac finding during OLT. The advantages of TEE are twofold, offering both immediate recognition and prompt management of complications …”

Section: Resultsmentioning

confidence: 99%

“…76 The most common abnormal intra-operative TEE findings during OLT are right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) with a left-to-right shunt. 76 However, left ventricular outflow tract obstruction is more difficult to diagnose, and very few reports describe this dynamic problem. 8,72 The same may be true for the diagnosis of left ventricular ballooning syndrome following reperfusion.…”

Section: Con Clus Ionmentioning

confidence: 99%

Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

et al. 2018

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The first perioperative transesophageal echocardiography (TEE) guidelines published 21 years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT. However, left ventricular outflow tract obstruction and left ventricular ballooning syndrome are more difficult to recognize and less frequent. Transesophageal ultrasonography (TEU) during OLT is also underused. Its applications are as follows: (1) assistance in the difficult placement of pulmonary arterial catheters; (2) help with catheterization of great vessels for external veno-venous bypass placement; (3) intra-operative evaluation of surgical liver anastomosis patency, if feasible, through the liver window; and (4) intra-operative investigation of "acute hypoxemia" due to pulmonary and cardiac issues using trans-esophageal lung ultrasound (TELU). The aims of this review are as follows: (1) to summarize the uses of TEE and TEU throughout all phases of OLT, and (2) to describe other new feasible applications.

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“…ICT was associated with likelihood of early (30 days) and late (1 year) major postoperative adverse events and decreased survival (OR = 4.7, OR = 3.15, and OR = 3.46, resp.) [12]. …”

Section: Discussionmentioning

confidence: 99%

Emergent Management of Intracardiac Thrombosis during Liver Transplantation

Protin

Bezinover

Kadry

et al. 2016

Case Reports in Transplantation

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Intraoperative thromboembolism is a well-documented complication associated with orthotopic liver transplantation (OLT) but its identification and intraoperative treatment are still an emerging topic in anesthesia. Intracardiac thrombus during OLT is associated with a high mortality rate. There are only a few reports describing the successful management of thromboembolism during OLT. We describe a case where routine intraoperative transesophageal echocardiography during a live donor liver transplantation enabled early detection of an intracardiac thrombus with subsequent successful heparin treatment. Our case suggests that if an intracardiac thrombus is identified early (before hemodynamic instability occurs), the use of IV heparin may be a safe therapeutic option.

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Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events

Cited by 54 publications

References 23 publications

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study

Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

Emergent Management of Intracardiac Thrombosis during Liver Transplantation

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