Venous excess ultrasound score in mitral valve disease patients undergoing mitral valve surgery and risk of post-operative kidney and liver injury: A prospective observational study

Recruitment of the patients will be done after the completion of CTRI registration. Patients satisfying the eligibility criteria will be included in the study after obtaining written informed consent. Before anaesthetic induction 2ml of venous blood sample will be obtained for BNP evaluation. Transthoracic echocardiographic examination and ultrasound scanning of liver and kidney will also be done before anaesthetic induction. Induction choice and insertion of pulmonary artery catheter will be based on the discretion of attending anaesthesiologist. Assessment of venous congestion will be performed using doppler based techniques. maximum size of IVC will be measured at the level of drainage of hepatic veins into IVC. Patients with IVC size of more than 2cms will be considered as having venous congestion and the patient will undergo further scanning of hepatic vein, portal vein and renal vein to quantify the intra-abdominal venous congestion. Those with IVC size less than 2cms will be labelled as VExUS score of 0 and no further scanning will be performed. Corresponding to the level of venous congestion VExUS score will be obtained. The primary outcome will be the composite of kidney and liver dysfunction. Acute kidney injury will be defined by the KDIGO criteria and acute liver injury will be defined as postoperative 1.5 times rise in ALT/AST/GGT during any time of index hospitalisation after cardiac surgery. Data concerning the performed procedure will be collected including duration of surgery, total fluid administration, duration of cardiopulmonary bypass, duration of cross-clamp time, urine output, blood loss, blood transfusion and vasoactive inotropic score will be obtained. The duration of mechanical ventilation, ICU stay, length of hospital stay and other major organ complications ( cardiovascular and neurological ) including mortality will be recorded during the hospital stay. All patients enrolled in the study will be further followed up in OPDs and if not will be followed up with a telephone call at 30 and 60 days after the hospital discharge to assess the rate of re-hospitalisation and death.