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Preliminary Results of Supra-Hepatic Intraaortic Perfusion with Nitroglycerin for Patients with Significant Hepatic Dysfunction
- Source :
- The Heart Surgery Forum. 15:150
- Publication Year :
- 2012
- Publisher :
- Carden Jennings Publishing Co., 2012.
-
Abstract
- Background: Preoperative hepatic dysfunction is a risk factor for postoperative fulminant hepatic failure and death. We noted persistent hepatic artery vasospasm in patients dying of postoperative hepatic failure. We hypothesized that an intra-aortic vasodilator such as nitroglycerin could attenuate vasospasm and prevent hepatic failure.Methods: Nineteen consecutive patients with significant preoperative hepatic dysfunction underwent cardiac surgery using cardiopulmonary bypass with continuous infusion of intra-aortic nitroglycerin via a catheter placed above the celiac axis. Serial hepatic artery Doppler studies were done perioperatively with and without the nitroglycerin infusion on. Hepatic artery Doppler, hepatic artery size, alterations in liver function and serum creatinine, and outcomes were noted. Survival was compared to the Euroscore and a hepatic risk score that was based on a historical cohort and reported literature.Results: One patient could not be weaned off cardiopulmonary bypass. In the remaining 18 patients, reversible hepatic arterial vasospasm was noted, and this persisted at 24 hours in 12 patients and 48 hours in 7 patients. All patients had resolution of vasospasm at 72 hours. Serial paired hepatic artery diameter measurements showed a significant difference (P < .001). There was a significant reduction in mortality (5.2 %) compared to historical control and predicted mortality (logistic Euroscore 37.4%, P = .023). None of the survivors had a significant alteration in hepato-renal function.Conclusion: Intra-aortic nitroglycerin can attenuate hepatic arterial vasospasm induced by cardiopulmonary bypass and preserve hepatic function. This may reduce the risk associated with cardiopulmonary bypass and surgery in patients with liver dysfunction.
- Subjects :
- Adult
Male
medicine.medical_specialty
Premedication
Vasodilator Agents
Pilot Projects
law.invention
Nitroglycerin
Young Adult
Hepatic Artery
Fulminant hepatic failure
law
Internal medicine
Cardiopulmonary bypass
medicine
Humans
Aged
Aged, 80 and over
business.industry
Cardiovascular Surgical Procedures
EuroSCORE
Vasospasm
Middle Aged
medicine.disease
Cardiac surgery
Treatment Outcome
medicine.anatomical_structure
Anesthesia
cardiovascular system
Cardiology
Female
Surgery
Liver function
Cardiology and Cardiovascular Medicine
business
Perfusion
Liver Failure
Artery
Subjects
Details
- ISSN :
- 15226662 and 10983511
- Volume :
- 15
- Database :
- OpenAIRE
- Journal :
- The Heart Surgery Forum
- Accession number :
- edsair.doi.dedup.....094d62a365e29021ee54d6666b2cb6d2
- Full Text :
- https://doi.org/10.1532/hsf98.20111129