Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Ann Card Anaesth. 2023 Oct-Dec;26(4):367-379. doi: 10.4103/aca.aca_186_22.
Orthotopic liver transplantation (OLT) is the standard of care for patients suffering from end stage liver disease (ESLD). This is a high-risk procedure with the potential for hemorrhage, large shifts in preload and afterload, and release of vasoactive mediators that can have profound effects on hemodynamic equilibrium. In addition, patients with ESLD can have preexisting coronary artery disease, cirrhotic cardiomyopathy, porto-pulomary hypertension and imbalanced coagulation. As cardiovascular involvement is invariable and patient are at an appreciable risk of intraoperative cardiac arrest, Trans esophageal echocardiography (TEE) is increasingly becoming a routinely utilized monitor during OLT in patients without contraindications to its use. A comprehensive TEE assessment performed by trained operators provides a wealth of information on baseline cardiac function, while a focused study specific for the ESLD patients can help in prompt diagnosis and treatment of critical events. Future studies utilizing TEE will eventually optimize examination safety, quality, permit patient risk stratification, provide intraoperative guidance, and allow for evaluation of graft vasculature.
原位肝移植（OLT）是治疗终末期肝病（ESLD）患者的标准方法。这是一种高风险的手术，可能会导致出血、前负荷和后负荷的大幅变化，以及血管活性介质的释放，这些都会对血液动力学平衡产生深远影响。此外，ESLD 患者可能存在先前存在的冠状动脉疾病、肝硬化性心肌病、门肺高压和凝血失衡。由于心血管受累是不可避免的，并且患者在术中心脏骤停的风险相当大，因此在没有使用 TEE 禁忌的情况下，TEE 越来越成为 OLT 期间常规使用的监测手段。由经过培训的操作人员进行的全面 TEE 评估提供了大量关于基线心脏功能的信息，而针对 ESLD 患者的重点研究有助于快速诊断和治疗危急事件。未来使用 TEE 的研究最终将优化检查的安全性、质量，允许患者进行风险分层，提供术中指导，并评估移植物血管。
