In Situ Hypothermic Perfusion with Retrograde Outflow During Right Hemihepatectomy: First Experiences with a New Technique Megan J. Reiniers, MS, Rowan.

Slides:

Advertisements

Similar presentations

Date of download: 6/1/2016 Copyright © 2016 SPIE. All rights reserved. Camera-phone laser speckle contrast analysis imaging. (a) Experimental arrangement.

Advertisements

Volume 126, Issue 2, Pages (August 2004)

Volume 66, Issue 4, Pages (April 2017)

Ultrasound-guided percutaneous delivery of tissue-engineered endothelial cells to the adventitia of stented arteries controls the response to vascular.

Volume 67, Issue 2, Pages (August 2017)

Bernardo C. Mendes, MD, Gustavo S. Oderich, MD, Thanila A

Elevation of hemopexin-like fragment of matrix metalloproteinase-2 tissue levels inhibits ischemic wound healing and angiogenesis April E. Nedeau, MD,

Stenotic false lumen as inflow of coronary aneurysm and full-metal jacket Suguru Ohira, MD, PhD, Hitoshi Yaku, MD, PhD, Shuichiro Takanashi, MD, PhD

Procedure-Specific Trends in Surgical Outcomes

Predicting Pediatric Patients Who Require Care at a Trauma Center: Analysis of Injuries and Other Factors Andrea N. Doud, MD, Samantha L. Schoell, PhD,

The influence of early-phase remodeling events on the biomechanical properties of engineered vascular tissues Zehra Tosun, Carolina Villegas-Montoya,

Therapeutic distant organ effects of regional hypothermia during mesenteric ischemia- reperfusion injury Rachel J. Santora, MD, Mihaela L. Lie, MD, Dmitry.

Three-Dimensional Virtual Endoscopy for Laparoscopic and Thoracoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD, PhD, Tomotake Koizumi,

Inferior vena cava graft-enteric fistula after extended hepatectomy with caval replacement Pietro Addeo, MD, Edoardo Rosso, MD, Elie Oussoultzoglou,

U. Jaffer, M. Aslam, V. Kasivisvanathan, R. Patni, M. Midwinter, N

Computational fluid dynamic analysis of the effect of morphologic features on distraction forces in fenestrated stent grafts Steven M. Jones, MBChB,

Gale Tang, MD, David N. Charo, Rong Wang, PhD, Israel F

Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence André M van Rij, MD, FRACS, Gregory T Jones, PhD, Gerry B Hill,

A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without.

Time-resolved magnetic resonance angiography and flow-sensitive 4-dimensional magnetic resonance imaging at 3 Tesla for blood flow and wall shear stress.

Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip Ted R. Kohler, MD, Thomas R. Kirkman, BS Journal.

Volume 67, Issue 2, Pages (August 2017)

Volume 136, Issue 2, Pages e4 (February 2009)

Intravascular ultrasonography allows accurate assessment of abdominal aortic aneurysm: An in vitro validation study Jeroen A. van Essen, MD, Aad van.

Ultrasound determination of total arterial wall thickness

Christian D. Etz, MD, PhD, Fabian A. Kari, MD, Christoph S

Risk of stroke early after implantation of a left ventricular assist device Takaaki Samura, MD, Daisuke Yoshioka, MD, PhD, Koichi Toda, MD, PhD, Ryoto.

Increased vascularization of shoulder regions of carotid atherosclerotic plaques from patients with diabetes Fredrik J. Olson, PhD, Sofia Strömberg,

Complete thoracoscopic S9 or S10 segmentectomy through a pulmonary ligament approach Takuma Kikkawa, MD, Masato Kanzaki, MD, PhD, Tamami Isaka, MD, PhD,

Asymmetric aortic expansion of the aneurysm neck: Analysis and visualization of shape changes with electrocardiogram-gated magnetic resonance imaging

Three-dimensional flow characteristics in ventricular assist devices: Impact of valve design and operating conditions Christoph Benk, MSc, Ramona Lorenz,

Biodegradable elastic patch plasty ameliorates left ventricular adverse remodeling after ischemia–reperfusion injury: A preclinical study of a porous.

Endoscopic Extrabursal Excision of Olecranon Spur

Ramon Berguer, M.D., Ph.D. Journal of Vascular Surgery

Mauro Lo Rito, MD, Tamadhir Gazzaz, MD, Travis J. Wilder, MD, Rachel D

A Patient-Centered Early Warning System to Prevent Readmission after Colorectal Surgery: A National Consensus Using the Delphi Method Linda T. Li, MD,

Structural analysis and magnetic resonance imaging predict plaque vulnerability: A study comparing symptomatic and asymptomatic individuals Zhi-Yong.

Perceived Complexity of Various Liver Resections: Results of a Survey of Experts with Development of a Complexity Score and Classification Major K. Lee,

Therapeutic site selection is important for the successful development of collateral vessels Ayako Nishiyama, MD, PhD, Hiroyuki Koyama, MD, PhD, Tetsuro.

Ultrasound-guided percutaneous delivery of tissue-engineered endothelial cells to the adventitia of stented arteries controls the response to vascular.

Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model Eric N. Feins, MD, Haruo Yamauchi, MD, PhD, Gerald R.

The protective effect of prone lung position on ischemia–reperfusion injury and lung function in an ex vivo porcine lung model Hiromichi Niikawa, MD,

Challenges in analysis and interpretation of cost data in vascular surgery Kevin Mani, MD, Jonas Lundkvist, RPh, PhD, Lars Holmberg, MD, PhD, Anders Wanhainen,

Preoperative Tattooing for Precise and Expedient Localization of Landmark in Laparoscopic Liver Resection Takeshi Aoki, MD, PhD, Masahiko Murakami, MD,

Extended Segmentectomy II to Left Hepatic Vein: Importance of Preserving Umbilical Fissure Vein to Avoid Congestion of Segment III Kosuke Kobayashi,

Reduced pleural drainage, length of stay, and readmissions using a modified Fontan management protocol Nancy A. Pike, PhD, Carol A. Okuhara, MN, Joy.

EUS targeting of vascular thrombosis: Risky business?

Volume 128, Issue 1, Pages (January 2005)

Solutions to the discrepancies in the extent of liver damage following ischemia/reperfusion in standard mouse models Rowan F. van Golen, Megan J. Reiniers,

Vascular endothelial growth factor enhances angiotensin II-induced aneurysm formation in apolipoprotein E-deficient mice Edward Choke, PhD, MRCS, Gillian.

A novel minimally invasive off-pump biventricular assist device insertion technique Zain Khalpey, MD, PhD, Richard Smith, MSEE, Angela Echeverria, MD,

Hypotension After Cardiac Operations Based on Autoregulation Monitoring Leads to Brain Cellular Injury Daijiro Hori, MD, Masahiro Ono, MD, PhD, Thomas.

Clinical correlates of lung ventilation defects in asthmatic children

Subacute limb ischemia induces skeletal muscle injury in genetically susceptible mice independent of vascular density Joseph M. McClung, PhD, Timothy.

Masahiro Ono, MD, PhD, Charles Brown, MD, Jennifer K

Jeanne M. LaBerge, MD, Ernest J. Ring, MD, John R. Lake, MD, Linda D

Coronary blood supply of the inferior wall of the right ventricle in hearts with Ebstein malformation: relevance to vertical plication Iki Adachi, MD,

Revascularization of cerebral ischemia after previous bilateral extracranial-intracranial bypass procedures V.S. Sottiurai, MD, PhD, L. Herbert, MD,

Combining Cerebral Perfusion With Retrograde Inferior Vena Caval Perfusion for Aortic Arch Surgery Jing Lin, MD, Jiyue Xiong, MS, Ming Luo, MS, Zhaoxia.

Computer-assisted Hydrodynamic Gene Delivery

Rationale and practical techniques for mouse models of early vein graft adaptations Peng Yu, MD, Binh T. Nguyen, MD, Ming Tao, MD, Christina Campagna,

Perfusion and repair technique in acute aortic dissection with cerebral malperfusion and damage of the innominate artery Paul P. Urbanski, MD, PhD, Matthias.

Venkat Maruthamuthu, Margaret L. Gardel Biophysical Journal

Spinal cord ischemia following operations on the abdominal aorta

Novel dynamic culture system to support initiation of primordial follicle growth in prepubertal mouse ovaries Katharina Winkler-Crepaz, M.D., Verena.

Surgical treatment of an aneurysm involving ascending aorta, aortic arch, and a rupture of a descending aortic aneurysm 26 years following acute type.

Reconstruction of the ligated external carotid artery for embolization of cervicofacial arteriovenous malformations Thomas S. Riles, MD, Alejandro Berenstein,

Journal of the American College of Surgeons

Blake Cady, MD, Thomas Miner, MD, Abraham Morgentaler, MD

Intrahepatic Glissonean Pedicle Approach to Segment 7 from the Dorsal Side During Laparoscopic Anatomic Hepatectomy of the Cranial Part of the Right Liver

Presentation transcript:

In Situ Hypothermic Perfusion with Retrograde Outflow During Right Hemihepatectomy: First Experiences with a New Technique Megan J. Reiniers, MS, Rowan F. van Golen, MS, Michal Heger, PhD, Banafsche Mearadji, MD, PhD, Roelof J. Bennink, MD, PhD, Joanne Verheij, MD, PhD, Thomas M. van Gulik, MD, PhD Journal of the American College of Surgeons Volume 218, Issue 1, Pages e7-e16 (January 2014) DOI: 10.1016/j.jamcollsurg.2013.09.013 Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 1 The liver during in situ hypotermic perfusion (with retrograde outflow) (IHP-R). The right hepatic artery and the right portal vein branch were cut, after which the right hepatic artery stump was cannulated and connected to the perfusion setup (Fig. 3). Subsequently, vascular inflow occlusion (VIO) was applied and the left and middle hepatic vein (or the confluence thereof) were occluded (depicted above). This situation allows for IHP-R, in which pressurized (<100 mmHg) 4°C lactated Ringer's solution enters the liver via the right hepatic artery stump, the solution courses through the left hemiliver (dashed arrows), and drainage occurs in a retrograde fashion via the cut end of the right portal vein branch. Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 2 Photographic images of in situ hypotermic perfusion (with retrograde outflow) (IHP-R). The different phases of IHP-R are depicted. (A) The right hepatic artery (RHA) and portal vein (PV) were dissected free and the hepatic pedicle was looped with a Mersilene sling as a tourniquet (pedicle sling). (B) The situation after cutting and cannulation of the RHA with an arterial cannula. (C) The middle and left hepatic vein (MHV and LHV, respectively) were secured with Mersilene slings and the line of transection, which follows the demarcation that resulted from severing the RHA and right PV branch, was marked on the liver surface using diathermy. (D) The final phase of parenchymal transection, during which the hepatic pedicle, MHV, and LHV were occluded and IHP-R was applied. Blanching of the left liver segments was apparent and a needle temperature probe was inserted into segment 4 to monitor the liver core temperature. (E) The liver remnant shortly after reperfusion, in which the normal color of the liver was restored. Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 3 Schematic overview of the perfusion setup of in situ hypotermic perfusion with retrograde outflow (IHP-R). The right hepatic artery was cannulated with an 8-Fr wire-bound arterial cannula (center right) that was connected to the perfusion setup (center left). The perfusion setup consisted of 2 bags of chilled lactated Ringer's solution that were placed in a dual pressure chamber and connected to the arterial cannula via a dual infusion system (depicted on the left). Efflux of the perfusion fluid occurred in a retrograde fashion through the right portal vein branch and the perfusate was subsequently removed from the surgical field by suction (right upper corner). During IHP-R, the pressure in the perfusion setup as well as the liver (TLIVER) and body temperature (TBODY) were monitored on the anesthesia workstation, indicated by the top and bottom graph, respectively (right lower corner). The liver core temperature was measured using a needle temperature probe that was inserted into the liver tissue (depicted on the right). Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 4 Body and liver core temperature during in situ hypotermic perfusion with retrograde outflow (IHP-R). The median and range (n = 3 participants) body (TBODY, blue line) and liver core (TLIVER, red line) temperature during IHP-R are plotted over time. The bars depicted above indicate the median and range in the duration of ischemia and IHP-R (perfusion). Three phases are distinguished: an active cooling phase during which the liver core temperature was reduced to the target temperature of 28°C, a maintenance phase during which the liver core temperature was maintained at 28°C, and a rewarming phase during which the liver core temperature was allowed to recover to body temperature. Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 5 Histology of the nontumorous tissue of 2 patients. Representative images of hematoxylin and eosin-stained nontumorous sections from the resected liver specimens of 2 patients. (A) Liver tissue from patient 5 (Tables 1 and 3) with grade 1 sinusoidal dilation33 (yellow arrowheads) and minimal portal inflammation (green arrowheads). (B) Liver tissue from patient 4 (Tables 1 and 3) with 15% to 20% steatosis (blue arrowheads) and some intracellular bilirubinostasis (inset, black arrowheads). Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 6 Functional and volumetric liver regeneration after in situ hypotermic perfusion with retrograde outflow. Function and volume of the (future) remnant liver ([F]RL) were determined preoperatively and on postoperative day 3. (A) A box-and-whisker plot of the calculated (F)RL function, suggesting an increase in remnant liver function on postoperative day 3 compared with the preoperatively calculated values. (B) A box-and-whisker plot of the (F)RL volume at both time points with a trend towards an increase in liver volume on postoperative day 3 compared with the preoperatively calculated values. Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 7 Relative increase in postoperative liver function and volume in patients who underwent in situ hypotermic perfusion with retrograde outflow (IHP-R) and in an historic cohort. The relative increase in (future) remnant liver ([F]RL) function and volume compared to preoperatively determined values was calculated (in %) for the IHP-R group as well as for a historic cohort of 12 patients that had undergone a major hepatectomy. (A) The relative increase in (F)RL function in the IHP-R group on postoperative day 3 and in the historic cohort on postoperative days 1 and 90. The relative increase in liver function is significantly greater in the IHP-R group on postoperative day 3 compared to the historic cohort on postoperative day 1 (p = 0.0044, Mann-Whitney U test), but not compared to the historic cohort on postoperative day 90 (p = 0.9517, Mann-Whitney U test). (B) The relative increase in (F)RL volume in the IHP-R group on postoperative day 3 and in the historic cohort on postoperative day 90, which are not significantly different (p = 0.3631, Mann-Whitney U test). Journal of the American College of Surgeons 2014 218, e7-e16DOI: (10.1016/j.jamcollsurg.2013.09.013) Copyright © 2014 American College of Surgeons Terms and Conditions