effects of hypothermic versus normothermic cardiopulmonary bypass on hepatic blood flow

To explore Trans-esophageal Echo [TEE] as a monitoring device for hepatic blood flow during cardiac1 surgery and to correlate between the hepatic venous blood flow measurements and the liver function tests during normothermic and hypothermic cardiopulmonary bypass. Forty patients scheduled for cardiac surgery were randomly divided into 2 groups: group 1 [Gl] undergoing normothermic cardiopulmonary bypass [CPB] and group 2 [G2] undergoing hypothermic CPB. Serum AST, ALT, billirubin and hyalurinic acid levels were measured before, during and 6 hours after the bypass. During these same phases, TEE was used to measure both cardiac index [Cl] and middle hepatic vein blood flow. During CPB there were no significant differences in demographic data, AST, ALT or billirubin levels between the 2 groups. There was, however, a significant increase [P<0.001], in both groups, in serum hyalurinic acid levels during CBP in relation to the baseline and in Cl 6 hours after bypass in relation to pre and intra bypass phases. The middle hepatic venous blood flow was significantly higher amongst Gl patients six hours following the procedure in relation to the pre and intra bypass phases, whereas G2 patients showed a significant decrease in middle hepatic venous flow during the bypass followed by a significant increase 6 hours after the procedure in relation to the baseline. Hepatic venous blood flow is reduced significantly more during hypothermic bypass than during normothermic bypass. This may cause disturbances in sinusoidal endothelial cell [SEC] function. However, this change may be well tolerated by the healthy liver. Multiplan TEE may be used to monitor hepatic blood flow during CPB

role of recombinant factor VII in controlling the intraoperative blood loss in patients with severe coagulopathy and portal hypertension during living donor liver transplant surgery

Liver transplantation is the standard form of treatment for patients with end stage liver disease, with the use of blood product as a standard method for transfusion. Recombinant factor Vila [rVlla] may help those patients to acquire less amount of transfusion. This will have an impact not only the morbidity and mortality of the recipient and the donor, but also on the economical aspect of this tremendously expensive procedure. We conducted this study to verify the possible beneficial effects of using rVlla at a lower dose than the standard dosage, which could have an impact on the future use of rVlla. Twenty-four patients scheduled for orthotropic livertransplantation, divided into 2 groups; a control group and an rVlla group. Both groups received the same anesthetics enlisted in our protocol for liver transplantation. The rVlla group received a loading dose of 30 microg/kg of rVlla following the induction of anesthesia, followed by a maintenance dose of 5 microg / kg until the end of the dissection phase. Demographic data, coagulation profile [prothrombin time [PT], prothrombin concentration [PC], partial thromboplastin time [PTT], International normalized ratio [INR]], blood loss, transfusion requirements, the duration of the dissection phase, the duration of surgery, hemoglobin concentration [Hb], and platelet count were done immediately after induction and 1, 2, 3 and 6 hours post induction [dissection phase]. Finally, a Doppler assessment of the graft vessels was performed subsequent to anastomosis. The rVlla group had a lower PT in the first two hours of the dissection phase in relation to the baseline and significantly lower than the control group [P = 0.0002]. The INR showed a significant improvement in the rVlla group during the dissection phase compared to the control group, and during the first two hours compared with the baseline in the rVlla group [P = 0.0002]. When compared to the control group, the rVlla group had a significant increase in the platelet count, in all samples taken during the dissection phase. There was a significant decrease in the intraoperative requirements of packed red blood cells [P = 0.014], platelets [P = 0.0005] and fresh frozen plasma [P = 0.01] in the rVlla group compared to the control group. We conclude that administering low dose of rVlla would be helpful during liver transplantation surgery. Improvement in the coagulation profile, transfusion requirements, and consequently postoperative morbidity and mortality could be achieved