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The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation

Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic va...

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Autores principales: Jeong, Young Hyun, Yang, Seong-Mi, Cho, Hyeyeon, Ju, Jae-Woo, Jang, Hwan Suk, Lee, Ho-Jin, Kim, Won Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432510/
https://www.ncbi.nlm.nih.gov/pubmed/34501470
http://dx.doi.org/10.3390/jcm10174022
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author Jeong, Young Hyun
Yang, Seong-Mi
Cho, Hyeyeon
Ju, Jae-Woo
Jang, Hwan Suk
Lee, Ho-Jin
Kim, Won Ho
author_facet Jeong, Young Hyun
Yang, Seong-Mi
Cho, Hyeyeon
Ju, Jae-Woo
Jang, Hwan Suk
Lee, Ho-Jin
Kim, Won Ho
author_sort Jeong, Young Hyun
collection PubMed
description Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases at a tertiary care academic medical center. We collected intraoperative variables of baseline central venous pressure, baseline right ventricle end-diastolic volume, mixed venous oxygen saturation, intraoperative PVR and right and left ventricular stroke work indexes. Time-weighted means or area under the curve of intraoperative right and left ventricular stroke work indexes were calculated as exposure variables. One-year all-cause mortality or graft failure was our primary outcome. Cox proportional hazard regression analysis was performed to evaluate the association between exposure variables and one-year all-cause mortality or graft failure. Kaplan–Meier survival curve analysis of our primary outcome was performed for different time-weighted mean ventricular stroke work index groups. Cubic spline curve analysis was performed to evaluate the linear relationship between our exposure variables and primary outcome. Time-weighted mean right ventricular stroke work index was significantly associated with one-year all-cause mortality or graft failure (hazard ratio 1.21, 95% confidence interval (CI) 1.12–1.36, p < 0.001). However, there was no significant association between time-weighted mean left ventricular stroke work index, time-weighted mean PVR, PVR at the end of surgery and one-year mortality. Area under the curve of right ventricular stroke work index was also significantly associated with one-year mortality or graft failure (hazard ratio 1.24, 95% CI 1.15–1.37, p < 0.001). Kaplan–Meier survival curve analysis showed a significant difference in the survival between different mean right ventricular stroke work index groups (Log-rank test: p = 0.002). Cubic spline function curve showed the gradual increase in the risk of mortality with a positive slope with time-weighted mean right ventricular stroke work index. In conclusion, intraoperative elevated right ventricular stroke work index was significantly associated with poor patient or graft survival after liver transplantation. Intraoperative right ventricular stroke work index could be an intraoperative hemodynamic goal and prognostic marker for mortality after liver transplantation.
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spelling pubmed-84325102021-09-11 The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation Jeong, Young Hyun Yang, Seong-Mi Cho, Hyeyeon Ju, Jae-Woo Jang, Hwan Suk Lee, Ho-Jin Kim, Won Ho J Clin Med Article Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases at a tertiary care academic medical center. We collected intraoperative variables of baseline central venous pressure, baseline right ventricle end-diastolic volume, mixed venous oxygen saturation, intraoperative PVR and right and left ventricular stroke work indexes. Time-weighted means or area under the curve of intraoperative right and left ventricular stroke work indexes were calculated as exposure variables. One-year all-cause mortality or graft failure was our primary outcome. Cox proportional hazard regression analysis was performed to evaluate the association between exposure variables and one-year all-cause mortality or graft failure. Kaplan–Meier survival curve analysis of our primary outcome was performed for different time-weighted mean ventricular stroke work index groups. Cubic spline curve analysis was performed to evaluate the linear relationship between our exposure variables and primary outcome. Time-weighted mean right ventricular stroke work index was significantly associated with one-year all-cause mortality or graft failure (hazard ratio 1.21, 95% confidence interval (CI) 1.12–1.36, p < 0.001). However, there was no significant association between time-weighted mean left ventricular stroke work index, time-weighted mean PVR, PVR at the end of surgery and one-year mortality. Area under the curve of right ventricular stroke work index was also significantly associated with one-year mortality or graft failure (hazard ratio 1.24, 95% CI 1.15–1.37, p < 0.001). Kaplan–Meier survival curve analysis showed a significant difference in the survival between different mean right ventricular stroke work index groups (Log-rank test: p = 0.002). Cubic spline function curve showed the gradual increase in the risk of mortality with a positive slope with time-weighted mean right ventricular stroke work index. In conclusion, intraoperative elevated right ventricular stroke work index was significantly associated with poor patient or graft survival after liver transplantation. Intraoperative right ventricular stroke work index could be an intraoperative hemodynamic goal and prognostic marker for mortality after liver transplantation. MDPI 2021-09-06 /pmc/articles/PMC8432510/ /pubmed/34501470 http://dx.doi.org/10.3390/jcm10174022 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jeong, Young Hyun
Yang, Seong-Mi
Cho, Hyeyeon
Ju, Jae-Woo
Jang, Hwan Suk
Lee, Ho-Jin
Kim, Won Ho
The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title_full The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title_fullStr The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title_full_unstemmed The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title_short The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation
title_sort prognostic role of right ventricular stroke work index during liver transplantation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432510/
https://www.ncbi.nlm.nih.gov/pubmed/34501470
http://dx.doi.org/10.3390/jcm10174022
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