Petru O Bucur1,2,3, Mohamed Bekheit1,2, Chloe Audebert4,5, Amnah Othman6,7, Seddik Hammad6,8,9, Mylene Sebagh10, Marc-Antoine Allard1, Benoît Decante11, Adrian Friebel12, Elodie Miquelestorena-Standley13, Dirk Drasdo4,12, Jan G Hengstler8, Irene E Vignon-Clementel4,5, Eric Vibert1,2. 1. Unité INSERM 1193, Centre Hépato-Biliaire, Villejuif, France. 2. Unité INSERM3 1193, Villejuif, France. 3. Service de Chirurgie Digestive, CHU Trousseau, Tours, France. 4. INRIA Paris-Rocquencourt, Paris, France. 5. Sorbonne Universités, UPMC University Paris 6, Laboratoire Jacques-Louis Lions, Paris, France. 6. Leibniz Research Centre for Working Environment and Human Factors (IFADO), TU Dortmund University, Dortmund, Germany. 7. Leibniz Institut für Analytische Wissenschaften - ISAS e.V., Dortmund, Germany. 8. Department of Forensic Medicine and Veterinary Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt. 9. Molecular Hepatology - Alcohol Associated Diseases, Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Germany. 10. Pathology Department, AP-HP, Hôpital Kremlin-Bicètre, Kremlin-Bicètre, France. 11. Centre Chirurgicale Marie-Lannelongue, Experimental Surgery Unit, Le Plessis Robinson, France. 12. Interdisciplinary Centre for Bioinformatics (IZBI), University of Leipzig, Leipzig, Germany. 13. CHRU Tours, Laboratoire D'anatomie et Cytologie Patholoiques, Tours, France.
Abstract
OBJECTIVE: To investigate safety and efficacy of temporary portal hemodynamics modulation with a novel percutaneously adjustable vascular ring (MID-AVR) onto a porcine model of 75% hepatectomy. BACKGROUND: Postoperative liver failure is a leading cause of mortality after major hepatectomy. Portal flow modulation is an increasingly accepted concept to prevent postoperative liver failure. Nonetheless, the current strategies have shortcomings. METHODS: Resection was performed under hemodynamic monitoring in 17 large, white pigs allocated into 2 groups. Eight pigs had ring around the portal vein for 3 days with the aim of reducing changes in hemodynamics due to hepatectomy. Analysis of hemodynamics, laboratory, and histopathological parameters was performed. RESULTS: Percutaneous inflation, deflation, and removal of the MID-AVR were safe. Two (25%) pigs in the MID-AVR group and 4 (45%) controls died before day 3 (P = NS). A moderate increase of portal flow rate per liver mass after resection was associated with better survival (P = 0.017). The portocaval pressure gradient was lower after hepatectomy in the MID-AVR group (P = 0.001). Postoperative serum bilirubin levels were lower in the MID-AVR group (P = 0.007 at day 5). In the MID-AVR group, the Ki67 index was significantly higher on day 3 (P = 0.043) and the architectural derangement was lower (P < 0.05). Morphometric quantification of the bile canaliculi revealed a significantly lower number of intersection branches (P < 0.05) and intersection nodes (P < 0.001) on day 7 compared with the preoperative specimen, in the control group. These differences were not found in the ring group. CONCLUSIONS: MID-AVR is safe for portal hemodynamics modulation. It might improve liver regeneration by protecting liver microarchitecture.
OBJECTIVE: To investigate safety and efficacy of temporary portal hemodynamics modulation with a novel percutaneously adjustable vascular ring (MID-AVR) onto a porcine model of 75% hepatectomy. BACKGROUND:Postoperative liver failure is a leading cause of mortality after major hepatectomy. Portal flow modulation is an increasingly accepted concept to prevent postoperative liver failure. Nonetheless, the current strategies have shortcomings. METHODS: Resection was performed under hemodynamic monitoring in 17 large, whitepigs allocated into 2 groups. Eight pigs had ring around the portal vein for 3 days with the aim of reducing changes in hemodynamics due to hepatectomy. Analysis of hemodynamics, laboratory, and histopathological parameters was performed. RESULTS: Percutaneous inflation, deflation, and removal of the MID-AVR were safe. Two (25%) pigs in the MID-AVR group and 4 (45%) controls died before day 3 (P = NS). A moderate increase of portal flow rate per liver mass after resection was associated with better survival (P = 0.017). The portocaval pressure gradient was lower after hepatectomy in the MID-AVR group (P = 0.001). Postoperative serum bilirubin levels were lower in the MID-AVR group (P = 0.007 at day 5). In the MID-AVR group, the Ki67 index was significantly higher on day 3 (P = 0.043) and the architectural derangement was lower (P < 0.05). Morphometric quantification of the bile canaliculi revealed a significantly lower number of intersection branches (P < 0.05) and intersection nodes (P < 0.001) on day 7 compared with the preoperative specimen, in the control group. These differences were not found in the ring group. CONCLUSIONS: MID-AVR is safe for portal hemodynamics modulation. It might improve liver regeneration by protecting liver microarchitecture.
Authors: John S Hammond; Fred Godtliebsen; Sonja Steigen; I Neil Guha; Judy Wyatt; Arthur Revhaug; Dileep N Lobo; Kim E Mortensen Journal: Clin Sci (Lond) Date: 2019-01-15 Impact factor: 6.124