Abstract
PurposeIntraoperative transesophageal echocardiography (TEE) has commonly been used for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. Anesthesiologists may be dissuaded from using TEE in orthotopic liver transplantation (OLT) out of concern about rupture of esophageal varices. Complications associated with TEE in OLT were evaluated.MethodsWe retrospectively reviewed charts and TEE videos of all OLT cases from January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida).ResultsOf the 1811 OLTs performed, we identified 232 patients who underwent intraoperative TEE. Esophageal variceal status was documented during presurgical esophagogastroduodenoscopy in 230 of the 232 patients. Of these, 69 (30.0 %), had no varices; 113 (49.1 %), 41 (17.8 %), and 7 (3.0 %) had grades I, II, and III varices, respectively. Two patients (0.9 %) had no EGD performed because of acute liver failure. During OLT, 1 variceal rupture (0.4 %) occurred after placement of an oral gastric tube and TEE probe; the patient required intraoperative variceal banding. Most patients had preexisting coagulopathy at the time of probe placement. The mean (SD) laboratory test results were as follows: prothrombin time, 21.7 (6.6) seconds; international normalized ratio, 1.9 (1.3); partial thromboplastin time, 43.8 (13.3) seconds; platelet, 93.7 (60.8) × 1000/μL; and fibrinogen, 237.8 (127.6) mg/dL.ConclusionTEE was a relatively safe procedure with a low incidence of major hemorrhagic complications in patients with documented esophagogastric varices and coagulopathy undergoing OLT. It appeared to effectively disclose cardiac information and allowed rapid reaction for proper patient management.
Highlights
Intraoperative transesophageal echocardiography (TEE) has become an important part of an anesthesiologist’s armamentarium for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases
The goal of this study was to investigate the complications associated with the use of intraoperative TEE during orthotopic liver transplantation (OLT) at our institution, adding new data to the open discussion regarding the safety of TEE in the OLT patient population
Most patients had preexisting coagulopathy at the time of probe placement
Summary
Intraoperative transesophageal echocardiography (TEE) has become an important part of an anesthesiologist’s armamentarium for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. End-stage liver disease is often associated with a hyperdynamic state, resulting in reduced systemic venous resistance and increased cardiac output. Cirrhotic cardiomyopathy can cause hemodynamic changes, diastolic and systolic dysfunction, electrophysiologic abnormalities, and segmental wall motion abnormalities (Fouad and Yehia 2014; Matsumori 2005; Teragaki et al 2003; Omura et al 2005; Therapondos et al 2004), which might be assessed using TEE. In the pre-anhepatic phase, hypotension may result from large fluid shifts after ascitic fluid removal or from decreased venous return caused
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