Is it necessary to measure hepatic venous pressure gradient before liver resection in cirrhotic patients? A single center audit

2021 ◽  
pp. 1-10
Author(s):  
Hassaan Bari ◽  
Sana Amir Akbar ◽  
Faisal Hanif
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Liver Resection ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Research Centre ◽  
Duration Of Surgery ◽  
Cirrhotic Patients ◽  
Gradient Measurements

Abstract Objective: To determine whether routine preoperative hepatic venous pressure gradient measurements are necessary in child’s-A cirrhotic patients undergoing liver resection for hepatocellular carcinoma, and to assess immediate post-operative liver dysfunction and 30-day mortality in such cases. Methods: The 3-year audit was done at Shuakat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, and comprised data from January 1, 2015, to December 31, 2017, of all Child’s class “A” patients with hepatocellular carcinoma without any clinical signs of portal hypertension who had preoperative hepatic venous pressure gradient measurements done were. A proforma was used to collect the required data from patient files. Data was analysed using SPSS 21. Results: Of the 20 patients, 11(55%) were males. The overall mean age was 60.6+7.4 years. Only 2(10%) patients had raised hepatic venous pressure gradient. Of the total, 14(70%) patients underwent surgery. Mean duration of surgery was 222+82.5 minutes and mean hospital stay was 6.8+3.2 days. None of the patients had deranged prothrombin-time or bilirubin on postoperative day 5. Conclusion: The incidence of subclinical portal hypertension was very low.  Hepatic venous pressure gradient measurement can be avoided in early stage hepatocellular carcinoma for child’s A cirrhotic patients undergoing liver resection. Key Words: Portal hypertension, Hepatic venous pressure gradient, Continuous...

scholarly journals Impact of propofol sedation on the diagnostic accuracy of hepatic venous pressure gradient measurements in patients with cirrhosis

2021 ◽  
Author(s):  
Fahim Ebrahimi ◽  
David Semela ◽  
Markus Heim
Keyword(s):  
Portal Hypertension ◽  
Pressure Gradient ◽  
Hepatic Vein ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Intraclass Correlation ◽  
Hepatic Venous Pressure Gradient ◽  
Propofol Sedation ◽  
Gradient Measurements ◽  
Awake Condition

Abstract Background Measurement of the hepatic venous pressure gradient (HVPG) is the gold standard to evaluate the presence and severity of portal hypertension. The procedure is generally safe and well tolerated, but nevertheless, some patients demand for sedation. However, it is unknown whether propofol sedation would impair the accuracy of portal pressure measurements. Methods This is a prospective observational cohort study including cirrhotic patients with suspected portal hypertension undergoing invasive measurement of HVPG. Measurements of HVPG were performed in awake condition as well as under sedation with propofol infusion. Results In total, 37 patients were included. Mean HVPG in awake condition was 15.9 mmHg (IQR 13–19) and during sedation 14.1 mmHg (IQR 12–17). While measures of free hepatic vein pressure (FHVP) were not altered after propofol sedation (p = 0.34), wedged hepatic vein pressure values (WHVP) decreased in an average by  2.05 mmHg (95% CI − 2.46 to − 1.16; p < 0.001) which was proportional to the magnitude of HVPG. In 31 out of 37 patients (83.8%), portal hypertension with HVPG ≥ 12 mmHg was found. Under sedation with propofol, two patients (5.4%) with borderline values would have been incorrectly classified as < 12 mmHg. After adjustment for the average difference of − 10%, all patients were correctly classified. Intraclass correlation coefficient between HVPG measurement in awake condition and under propofol sedation was 0.927 (95% CI 0.594–0.975). Conclusions Propofol sedation during HVPG measurements is generally safe, however it may lead to relevant alterations of HVPG readings.

Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma

2011 ◽  
Vol 98 (12) ◽  
pp. 1752-1758 ◽  
Author(s):  
S. Stremitzer ◽  
D. Tamandl ◽  
K. Kaczirek ◽  
J. Maresch ◽  
B. Abbasov ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Gradient Measurement

Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis

2012 ◽  
Vol 99 (6) ◽  
pp. 855-863 ◽  
Author(s):  
E. Boleslawski ◽  
G. Petrovai ◽  
S. Truant ◽  
S. Dharancy ◽  
A. Duhamel ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Resection ◽  
Pressure Gradient ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient

scholarly journals The Association Between Hepatic Venous Pressure Gradient Baseline and the Response Rate of Carvedilol on Portal Hypertension

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lifen Wang ◽  
Qian Ding ◽  
Xueying Wang ◽  
Xiangguo Tian ◽  
Guangchuan Wang ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Pressure Gradient ◽  
Response Rate ◽  
Venous Pressure ◽  
Hepatic Venous Pressure Gradient ◽  
Endoscopic Variceal Ligation ◽  
Significant Difference ◽  
Rebleeding Rate ◽  
Cirrhotic Patients

Objective: To assess the association between hepatic venous pressure gradient (HVPG) baseline and the response rate of cirrhotic in patients who received carvedilol treatment. Methods: In total 48 cirrhotic patients with a basic HVPG value greater than 12 mmHg were included (from July 2011 to October 2014). All patients received carvedilol treatment and underwent the second HVPG measurement 7 days later. In the following, all participants received an endoscopic variceal ligation (EVL) treatment. Results: HVPG was significantly reduced from 16.04 ± 3.10 to 12.76 ± 5.26 mmHg following carvedilol treatment. The response rate was about 58.33% (28/48). The response rate of the HVPG < 16 mmHg group (71.4%) was significantly higher than that of the HVPG ≥ 16 mmHg group (40%) (P < 0.05). Patients were followed up for a median of 26 months, ranged from 6 to 33 months. During the follow-up period (two years), the rebleeding rate was 9.97% and 49.56% in HVPG < 16 and HVPG ≥ 16 mmHg groups, respectively, with a statistically significant difference (P = 0.004). Also, the mortality rate (at 2 years) was 5.26% and 21.05%, respectively, which was significant (P = 0.035). Conclusions: This study demonstrated that the response rate of carvedilol on portal hypertension may be affected by the HVPG baseline, and the carvedilol was effective in reducing HVPG, especially for those with a HVPG < 16 mmHg.

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