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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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/17/4022 |
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| author | Young Hyun Jeong Seong-Mi Yang Hyeyeon Cho Jae-Woo Ju Hwan Suk Jang Ho-Jin Lee Won Ho Kim |
| author_facet | Young Hyun Jeong Seong-Mi Yang Hyeyeon Cho Jae-Woo Ju Hwan Suk Jang Ho-Jin Lee Won Ho Kim |
| author_sort | Young Hyun Jeong |
| collection | DOAJ |
| 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, <i>p</i> < 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, <i>p</i> < 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: <i>p</i> = 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. |
| first_indexed | 2024-03-10T08:08:31Z |
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| id | doaj.art-1e72ce21c9c3476e8bbc0d295ecf7bf4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T08:08:31Z |
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| spelling | doaj.art-1e72ce21c9c3476e8bbc0d295ecf7bf42023-11-22T10:50:55ZengMDPI AGJournal of Clinical Medicine2077-03832021-09-011017402210.3390/jcm10174022The Prognostic Role of Right Ventricular Stroke Work Index during Liver TransplantationYoung Hyun Jeong0Seong-Mi Yang1Hyeyeon Cho2Jae-Woo Ju3Hwan Suk Jang4Ho-Jin Lee5Won Ho Kim6Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaDepartment of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-gu, Seoul 03080, KoreaRight 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, <i>p</i> < 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, <i>p</i> < 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: <i>p</i> = 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.https://www.mdpi.com/2077-0383/10/17/4022right ventricular stroke work indexhemodynamicsliver transplantationmortality |
| spellingShingle | Young Hyun Jeong Seong-Mi Yang Hyeyeon Cho Jae-Woo Ju Hwan Suk Jang Ho-Jin Lee Won Ho Kim The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation Journal of Clinical Medicine right ventricular stroke work index hemodynamics liver transplantation mortality |
| 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 | right ventricular stroke work index hemodynamics liver transplantation mortality |
| url | https://www.mdpi.com/2077-0383/10/17/4022 |
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