The Strategy Of Planned Utility Of ECMO For Liver Transplantation In Patients With Pulmonary Hypertension In 3 Cases

Objective:Summarize the clinical characteristics of pulmonary hypertension（PH）in patients with end-stage liver disease,and explore the strategy and advantages of planned application of extracorporeal membrane oxygenation（ECMO）during liver transplantation.Methods:From November 2017 to July 2021,add up to 277 cases of orthotopic liver transplantation were performed in the liver transplantation center of the First Hospital of Jinlin University,of which 3 cases underwent preoperative multidisciplinary consultation and decided to complete liver transplantation through combined ECMO.The general data,laboratory examinations,imaging examinations,intraoperative hemodynamic data and follow-up status of these 3 patients were retrospectively analyzed.The diagnosis of pulmonary hypertension is based on transthoracic Doppler echocardiography（TDE）and right heart catheterization.Results:All 3 patients had symptoms of right ventricular dysfunction such as fatigue,chest tightness,and palpitations before surgery.The first case did not perform preoperative right heart catheterization due to the refusal of the patient;the second and third patients were screened by TDE and diagnosed as portopulmonary hypertension and PH related to left heart disease through right heart catheterization.The 3 recipients with PH all received catheterization in the right femoral artery and femoral vein after the diseased liver was freed and before the inferior vena cava was blocked,underwent V-A ECMO support,adjusted the amount of heparin according to activated clotting time（ACT）,and the perioperative vital signs were stable.Respectively,the ventilator support time and ECMO support time of the 3 recipients were 54h、12h、62 h and 27h、61h、14 h.All of them were discharged smoothly and have been followed up till now.Conclusion:Patients with end-stage liver disease with pulmonary hypertension should undergo routine TDE examinations during the waiting period before liver transplantation,which suggests that patients with PH should undergo further right heart catheterization to confirm the diagnosis and severity of the disease.The planned application of ECMO through multidisciplinary consultations can expand the surgical indications for liver transplantation,maintain perioperative cardiopulmonary function and hemodynamic stability,and play an important role in the smooth progress of liver transplantation and postoperative rehabilitation of patients.