Influence of perioperative fluid balance on clinical outcomes after hepatic resection in patients with left ventricular diastolic dysfunction

Background: Maintenance of low central venous pressure (CVP) during hepatic resection to minimize intraoperative blood loss requires compensative administration of large amounts of fluid after its completion. However, this fluid challenge may influence on the postoperative outcomes of patients with left ventricular diastolic dysfunction (LVDD) who cannot tolerate volume adjustment.MethodsA total of 206 patients with who underwent hepatic resection between March 2015 and February 2021 were evaluated. LVDD was defined according to the American Society of Echocardiography and the European Association of Cardiovascular Imaging 2016 recommendations as LVDD (group A, n = 39), or normal LV diastolic function and indeterminate decision (group B, n = 153).ResultsCVP at the end of surgery was significantly higher in group A than in group B (6.35 ± 3.45 vs. 5.12 ± 2.80, P  = 0.025). Postoperative acute kidney injury (AKI, 10.3% vs. 1.3%, P  = 0.004) and pleural effusion or edema (51.3% vs. 30.1%, P  = 0.013) were more common in group A than in group B. Further, creatinine levels from postoperative day 1 to day 7 were significantly higher and daily urine outputs at postoperative day 1 ( P  = 0.038) and day 2 ( P  = 0.025) were significantly lower in group A than in group B. LVDD was the only significant risk factor for postoperative AKI after hepatic resection (odds ratio, 10.181; 95% confidence interval, 1.570-66.011, P  = 0.015).ConclusionThe rates of renal dysfunction and pulmonary complications after hepatic resection are higher in patients with LVDD than in those with normal LV diastolic function. Thus, these patients require delicate fluid management.