Strain Analysis for Assessment of Myocardic Dysfunction During Orthotopic Liver Transplantation

Completed

• Conditions: Myocardial Dysfunction; Liver Transplant; Complications
• Interventions: Procedure: Longitudinal strain obtained thanks to transesophageal ultrasound data recorded during liver transplantation

• Registration Number: NCT05037838
• Lead Sponsor: Hospices Civils de Lyon

Brief Summary

Mycocardial systolic function (contractility) is an essential element of cardio-circulatory physiology during major visceral surgery, in particular during liver transplantation during which several factors are likely to be at the origin of a ventricular dysfunction: acute hemorrhage, major volume changes, acute pulmonary arterial hypertension and ischemia-reperfusion syndrome.

Ventricular dysfunction is an underestimated intraoperative liver transplantation phenomenon while it constitutes a risk factor for peroperative and postoperative morbidity and mortality established that graft function can be compromised through the phenomena of low cardiac output and hepatic congestion.

Also, better analyzing myocardial systolic function during liver transplantation could guide practitioners in the treatments to be undertaken, evaluate their effects and diagnose various complications.

In addition, the usual cardiac output measurement systems (transpulmonary thermodilution techniques and pulse wave contour analysis) are poorly suited to liver transplantation. Frequent variations in blood volume, vasomotor tone and temperature require regular recalibrations and prevent a continuous and reliable estimate of cardiac output.

Thus, the choice of hemodynamic monitoring during liver transplantation performed in our center is transesophageal ultrasound, a semi-invasive method with a favorable benefit-risk ratio in this category of the population. However, analysis of right ventricular systolic function by classical indices is difficult in transesophageal ultrasound for reasons of alignment of the ultrasound shot on the right ventricular. The analysis of left ventricular systolic function is complex due to the sudden variations in volume and the difficulty in carrying out planimetry measurements in real time.

Myocardial strain imaging has been developed in recent years and is widely validated for the assessment of left ventricular contractile function. It was subsequently applied to the exploration of the right ventricular. Its measurement can be performed from recordings on dedicated software.

Thus, the strain could make it possible to better assess myocardial systolic dysfunction in liver per-transplantation from the transesophageal echographic loops recorded in current practice at the different operating times. Strain measurements will be carried out a posteriori from the images which are acquired in a standard way during the operation.

Detailed Description

Not available

Basic Information
|
Recruitment & Eligibility
|
Study & Design
|
Trial Locations

Study Timeline

• Study Start: 2020-11-01
• Primary Completion: 2021-04-01
• Study Completion: 2021-05-30
• Status Verified: 2021-06
• Study First Submitted: 2021-08-31
• Study First Submitted QC: 2021-08-31
• Last Update Submitted: 2021-08-31
• Study First Posted: 2021-09-08
• Last Update Posted: 2021-09-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Age of 18 years old and more
• Patients undergoing a liver transplantation

Read More

Exclusion Criteria

• Contraindication to transesophageal ultrasound
• Refusal to participate
• Age <18 years old

Read More

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Patient undergoing a liver transplantation	Longitudinal strain obtained thanks to transesophageal ultrasound data recorded during liver transplantation	Patients undergoing a liver transplantation and able to have a transesopahageal ultrasound

Primary Outcome Measures

Name	Time	Method
variations of strain	The variations will be observed thanks to measurements done before incision, during the dissection phase, during the anhepatic period, during the reperfusion phase, during the biliary reconstruction and finally after the patient closure	Variations of left ventricular longitudinal strain and right ventricular free wall longitudinal strain obtained with transesophageal ultrasound data during each phase of orthotopic liver transplantation, The primary endpoint is to objective a myocardial dysfunction comparatively to baseline assessment.

Trial Locations

Locations (1)

Hopital de la Croix Rousse; 🇫🇷 Lyon, Rhone Alpes, France