PhD Scientific Days 2021

TT_I_P: Theoretical and Translational Medicine I. Posters

The association between preoperative hepatic venous flow and the outcome after cardiac surgery

Text of the abstract

Introduction: The hepatic venous flow reflects to the pressure changes of the right ventricle. Therefore, it starts to appear as a part of the echocardiographic examinations. Moreover, the back and forth link between the cardiovascular state and the liver is well-known for several years.
Aims: Our objective was to evaluate the association between preoperative hepatic venous flow and the outcome of patients underwent cardiac surgery.
Methods: Our prospective, observational study included 98 patients who underwent cardiac surgery between January 2018 and March 2020 at our Heart and Vascular Centre. Beside the routine echocardiographic examination we also measured the venous blood flow in the common hepatic vein before the influx into the Inferior Vena Cava with Doppler ultrasound. We recorded the standard four waves’ (V, D, S, A) maximal speed and velocity time integral (VTI). In our database we recorded the patients’ demographic data, preoperative and postoperative hemodynamic and hepatobiliar markers and the EuroSCORE. We collected the length of stay (LOS), the intensive care unit stay, the vasopressor and inotrope need, and the occurrence of acute kidney injury (AKI). Our primary outcome was AKI, it was defined by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines, which is one of the first signs of circulation problems. We used the SPSS 22 program to analyse our data, with descriptive parameters and Cox-regression analyses.
Results: Median age was 67.9 (IQR 25-75: 60.6-73.6), none of them had any liver or renal disease in their medical history. Most common surgical procedure was CABG (40%).
With Inverse Probability Weighting we found a significant difference at the S waves’ VTI, and the retrograde/anterograde waves’ VTI ratio after adjustment for age, Euroscore, diabetes and GFR. Multivariate Cox-regression analysis revealed, that the ratio of the retrograde and anterograde waves’ VTI had independent association with AKI (OR: 1.35; 95% CI: 1.03-1.75; p=0.027), the model was adjusted for the previous parameters, too.
Conclusion: The increment in the hepatic venous retrograde waves, which are related to hepatic stasis, can predict worse outcome among cardiac patients. Therefore, we might include this potentially useful tool in routine echocardiographic examinations.
Funding: No funds received.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine