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Liver blood flow during cardiac surgery

Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK

David AC Sharpe

Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK

Jay Nandi

Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK

Stephen J Butler

Department of Clinical Biochemistry, Blackpool Victoria Hospital, Blackpool, UK

Ian M Mitchell

Department of Cardiothoracic Surgery, Nottingham City Hospital, Nottingham, UK, imitchel{at}ncht.trent.nhs.uk

Objective: Impairment of liver blood flow and, therefore, potentially liver function, has important short-term consequences because of the liver’s key metabolic importance and role in drug metabolism. The objective of this study was to quantify the effect of cardiac surgery on liver blood flow from before the induction of anaesthesia to 24 hours postoperatively.

Method: Ten patients with no history of liver impairment, moderate or good left ventricular function, and undergoing routine hypothermic coronary artery bypass graft surgery, were entered into the study. Liver blood flow was determined by the clearance of indocyanine green (ICG), expressed as a percentage disappearance rate (PDR).

Results: The mean baseline percentage disappearence rate (PDR) of indocyanine green (ICG) was 19.849-4.47%/min. This increased marginally to 20.429-6.67%/min following the induction of anaesthesia, but after 15 min of cardiopulmonary bypass, the PDR fell to 13.519-3.69%/min; this was significantly lower than all other PDRs measured throughout the study. Prior to extubation, the PDR increased again to 20.019-3.72%-min, and this level was maintained at 12 hours (PDR 20.329-3.53%min) and 24 hours (PDR 20.519-2.27%/min).

Conclusion: The induction of anaesthesia and positive pressure ventilation do not affect liver blood flow. Cardiopulmonary bypass at 308C is associated with a significant reduction in liver blood flow, which returns to normal within 4 ^/ 6 hours of surgery and remains normal for up to 24 hours after surgery.

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