Postoperative alterations in ventriculo-arterial coupling is an indicator of cardiovascular outcomes in liver transplant recipients.

BACKGROUND: Liver transplantation (LT) surgery increase the workload on the heart and vessels in patients with cirrhotic cardiomyopathy. While the interaction of the left ventricle (LV) with the arterial system (ventricular-arterial coupling, VAC) is a key determinant of cardiovascular performance, little has been known about the changes in VAC after LT. Therefore, we evaluated the relationship between the VAC after LT and cardiovascular outcomes.

METHODS: A total of 344 consecutive patients received echocardiographic assessments before and within one month after LT. Noninvasive arterial elastance (Ea), LV end-systolic (Ees) elastance, and LV end-diastolic (Eed) elastance were calculated. Postoperative outcomes included the development of major adverse cardiovascular events (MACE) and length of stay in the intensive care unit (ICU) and the hospital.

RESULTS: After LT, Ea increased by 16% (P<0.001), and Ees and contractility index of S' increased by 18% (p<0.001) and 7% (p<0.001), respectively. The Eed increased by 6 % (p<0.001). The VAC remained unchanged (0.56 to 0.56, p=0.912). Of the patients, 29 had MACE and patients with MACE had significant higher postoperative VAC. Additionally, higher postoperative VAC was an independent risk factor for longer postoperative hospital stays (p=0.038).

CONCLUSIONS: These data suggest that the development of ventricular-arterial decoupling was associated with poor postoperative outcomes after LT.