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A percutaneous technique for venovenous bypass in orthotopic cadaver liver transplantation and comparison with the open technique
Author(s) -
Johnson Scott R.,
Marterre William F.,
Alonso Maria H.,
Hanto Douglas W.
Publication year - 1996
Publication title -
liver transplantation and surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1074-3022
DOI - 10.1002/lt.500020505
Subject(s) - medicine , percutaneous , orthotopic liver transplantation , cadaver , liver transplantation , transplantation , surgery
Venovenous bypass minimizes the hemodynamic alterations during the anhepatic phase of liver transplantation. A new technique for the percutaneous placement of the bypass cannulae is described and compared to the cut‐down (“open”) technique. The records of 81 patients who underwent 94 liver transplants between August 1991 and April 1994 were reviewed for indications for transplant, United Network for Organ Sharing status, mean age, body surface area, bypass technique and time, flow rates, cardiac output, mean arterial pressure and central venous pressure during bypass, the development of deep venous thrombophlebitis, and lymphoceles. Femoral flow rates were higher in the open group (2054 ± 74 mL/min), compared with the percutaneous group (1726 ± 74 mL/min) ( p = 0.003). Total flow rates in the open (2238 ± 58 mL/min) and percutaneous (2197 ± 67 mL/min) groups were not different. Maximum cardiac outputs (L/min) were higher in the open (10.1 ± 0.6) versus percutaneous group (7.0 ± 0.5) ( p < 0.0002). Similarly, minimum cardiac outputs (L/min) were higher in the open (8.9 ± 0.7) versus percutaneous group (5.8 ± 0.5) ( p = 0.003). Other hemodynamic parameters (mean arterial pressure, central venous pressure) were not different between groups. Venous thrombosis occurred in 1/50 (2.0%) and 4/34 (11.8%) patients in the open and percutaneous groups, respectively ( p = 0.153). Nineteen lymphoceles occurred in 102 (18.6%) at‐risk sites in the open group, whereas no lymphoceles occurred in 66 at‐risk sites in the percutaneous group ( p < 0.001). Groin lymphoceles occurred in 7/50 (14%) and 0/34 at‐risk sites in the open and percutaneous groups, respectively ( p = 0.039). Axillary lymphoceles occurred in 12/52 (23.1%) and 0/32 at‐risk sites in the open and percutaneous groups, respectively ( p = 0.0031). Operative repair of a lymphocele was required in 11/16 (69%) patients. The percutaneous placement of catheters for venovenous bypass has the advantage of comparable flow rates with satisfactory hemodynamics without the lymphatic complications of the cut‐down technique. Copyright © 1996 by the American Association for the Study of Liver Diseases.