Haemodynamic and metabolic changes during major liver resection with use of hepatic total vascular exclusion.

We evaluated haemodynamic changes during major liver resection that involved total hepatic vascular exclusion (HVE) carried out through clamping hepatic pedicle and inferior caval vein upper and above the liver. Fourteen patients, undergoing different procedures of major liver resection, were enrolled in this study which used complete cardiovascular monitoring. Haemodynamic parameters were measured and calculated at five different times during the operation. Changes such as reduction in cardiac output and increase in systemic vascular resistance, though significant, were well tolerated in all patients, allowing the execution of major liver surgery. HVE offers a significant reduction in haemorrhagic and air embolus risk, but it requires the use of complete haemodynamic monitoring to evaluate tolerance to clamping and correction of unavoidable cardiovascular changes.