Complications related to intraoperative transesophageal echocardiography in liver transplantation

Sher Lu Pai, Stephen Aniskevich, Neil G. Feinglass, Beth L. Ladlie, Claudia C. Crawford, Prith Peiris, Klaus D Torp, Timothy S. Shine

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: Intraoperative 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. Methods: We retrospectively reviewed charts and TEE videos of all OLT cases from January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida). Results: Of 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. Conclusion: TEE 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.

Original languageEnglish (US)
Article number480
JournalSpringerPlus
Volume4
Issue number1
DOIs
StatePublished - Dec 10 2015

Fingerprint

Transesophageal Echocardiography
Liver Transplantation
Varicose Veins
Rupture
Digestive System Endoscopy
International Normalized Ratio
Partial Thromboplastin Time
Acute Liver Failure
Esophageal and Gastric Varices
Prothrombin Time
Fibrinogen
Stomach
Blood Platelets
Hemodynamics
Incidence

Keywords

  • Coagulopathy
  • End-stage liver disease
  • Esophageal varices
  • Variceal bleed

ASJC Scopus subject areas

  • General

Cite this

Pai, S. L., Aniskevich, S., Feinglass, N. G., Ladlie, B. L., Crawford, C. C., Peiris, P., ... Shine, T. S. (2015). Complications related to intraoperative transesophageal echocardiography in liver transplantation. SpringerPlus, 4(1), [480]. https://doi.org/10.1186/s40064-015-1281-3

Complications related to intraoperative transesophageal echocardiography in liver transplantation. / Pai, Sher Lu; Aniskevich, Stephen; Feinglass, Neil G.; Ladlie, Beth L.; Crawford, Claudia C.; Peiris, Prith; Torp, Klaus D; Shine, Timothy S.

In: SpringerPlus, Vol. 4, No. 1, 480, 10.12.2015.

Research output: Contribution to journalArticle

Pai, SL, Aniskevich, S, Feinglass, NG, Ladlie, BL, Crawford, CC, Peiris, P, Torp, KD & Shine, TS 2015, 'Complications related to intraoperative transesophageal echocardiography in liver transplantation', SpringerPlus, vol. 4, no. 1, 480. https://doi.org/10.1186/s40064-015-1281-3
Pai SL, Aniskevich S, Feinglass NG, Ladlie BL, Crawford CC, Peiris P et al. Complications related to intraoperative transesophageal echocardiography in liver transplantation. SpringerPlus. 2015 Dec 10;4(1). 480. https://doi.org/10.1186/s40064-015-1281-3
Pai, Sher Lu ; Aniskevich, Stephen ; Feinglass, Neil G. ; Ladlie, Beth L. ; Crawford, Claudia C. ; Peiris, Prith ; Torp, Klaus D ; Shine, Timothy S. / Complications related to intraoperative transesophageal echocardiography in liver transplantation. In: SpringerPlus. 2015 ; Vol. 4, No. 1.
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abstract = "Purpose: Intraoperative 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. Methods: We retrospectively reviewed charts and TEE videos of all OLT cases from January 2003 through December 2013 at Mayo Clinic (Jacksonville, Florida). Results: Of 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. Conclusion: TEE 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.",
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