Liver Transplantation

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

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies. Design Data were collected retrospectively from the electronic medical record and institutional echocardiography database. Setting Single university hospital. Participants A total of 100 patients undergoing OLT via total cavaplasty technique. Interventions Intraoperative TEE was performed in all 3 phases of OLT. Measurement and Main Results TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40%), isolated right ventricular dysfunction (n = 22, 22%), and intracardiac thromboemboli (n = 20, 20%). Conclusions Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events.

Original languageEnglish (US)
Pages (from-to)107-114
Number of pages8
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2016

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Transesophageal Echocardiography
Liver Transplantation
Echocardiography
Reperfusion
Transplantation
Right Ventricular Dysfunction
Electronic Health Records
Dissection
Databases

Keywords

  • adverse cardiac events
  • liver transplant
  • thrombus
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

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title = "Liver Transplantation: Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events",
abstract = "Objective The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies. Design Data were collected retrospectively from the electronic medical record and institutional echocardiography database. Setting Single university hospital. Participants A total of 100 patients undergoing OLT via total cavaplasty technique. Interventions Intraoperative TEE was performed in all 3 phases of OLT. Measurement and Main Results TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40{\%}), isolated right ventricular dysfunction (n = 22, 22{\%}), and intracardiac thromboemboli (n = 20, 20{\%}). Conclusions Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events.",
keywords = "adverse cardiac events, liver transplant, thrombus, transesophageal echocardiography",
author = "Shillcutt, {Sasha K} and Ringenberg, {Kyle J.} and Chacon, {M. Megan} and Brakke, {Tara R} and Montzingo, {Candice R.} and Lyden, {Elizabeth R.} and Schulte, {Thomas E} and Porter, {Thomas Richard} and Lisco, {Steven J}",
year = "2016",
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language = "English (US)",
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TY - JOUR

T1 - Liver Transplantation

T2 - Intraoperative Transesophageal Echocardiography Findings and Relationship to Major Postoperative Adverse Cardiac Events

AU - Shillcutt, Sasha K

AU - Ringenberg, Kyle J.

AU - Chacon, M. Megan

AU - Brakke, Tara R

AU - Montzingo, Candice R.

AU - Lyden, Elizabeth R.

AU - Schulte, Thomas E

AU - Porter, Thomas Richard

AU - Lisco, Steven J

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies. Design Data were collected retrospectively from the electronic medical record and institutional echocardiography database. Setting Single university hospital. Participants A total of 100 patients undergoing OLT via total cavaplasty technique. Interventions Intraoperative TEE was performed in all 3 phases of OLT. Measurement and Main Results TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40%), isolated right ventricular dysfunction (n = 22, 22%), and intracardiac thromboemboli (n = 20, 20%). Conclusions Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events.

AB - Objective The primary aim of the study was to describe the most common intraoperative transesophageal echocardiography (TEE) findings during the 3 separate phases of orthotopic liver transplantation (OLT). The secondary aim of the study was to determine if the abnormal TEE findings were associated with major postoperative adverse cardiac events (MACE) and thus may be amenable to future management strategies. Design Data were collected retrospectively from the electronic medical record and institutional echocardiography database. Setting Single university hospital. Participants A total of 100 patients undergoing OLT via total cavaplasty technique. Interventions Intraoperative TEE was performed in all 3 phases of OLT. Measurement and Main Results TEE findings of 100 patients who had TEE during OLT during the dissection, anhepatic, and reperfusion phases of transplantation were recorded after blind review. Findings then were analyzed to see if those findings were predictive of postoperative MACE. Intraoperative TEE findings varied among the different phases of OLT. Common TEE findings at reperfusion were microemboli (n = 40, 40%), isolated right ventricular dysfunction (n = 22, 22%), and intracardiac thromboemboli (n = 20, 20%). Conclusions Intraoperative echocardiography findings during liver transplantation varied during each phase of transplantation. The presence of intracardiac thromboemboli or biventricular dysfunction on intraoperative echocardiography was predictive of short- and long-term major postoperative adverse cardiac events.

KW - adverse cardiac events

KW - liver transplant

KW - thrombus

KW - transesophageal echocardiography

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