Original Article

Cardiovascular Effects of Vena-Venous Bypass during Hepatic Transplantation

Baylor University Medical Center Dallas, TX

^* Direct communications to: A. William Paulsen, Ph. D., Department of Anesthesiology, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246

Abstract

(J. Extra-Corpor. Technol. 19[3] p. 268-273 Fall 1987, 12 ref). A series of 42 orthotopic hepatic transplant patients were reviewed retrospectively to determine the cardiovascular effects of heparinless venavenous bypass using a constrained vortex pump. Pump flows and cardiac outputs fell progressively during bypass. During the bypass period the vascular volume became hemoconcentrated as indicated by increases in hematocrit, colloid osmotic pressure, serum osmolality, and serium sodium. The changes in colloid osmotic pressure were inversely related to the bypass pump flow. Transient hemodynamics occurring at the onset of bypass included decreases in temperature, heart rate, arterial pressure, and increases in pulmonary artery pressure, central venous pressure and T wave amplitude. Core temperature changed at the rate of -0.89°C per hour during the bypass period as compared to -0.31°C during the previous phase of the procedure. Veno-venous bypass may improve hemodynamic stability during the anhepatic phase of the procedure, but the abdomen and lower extremities may be less than optimally perfused.