Modulating Portal Hemodynamics with Vascular Ring Allows Efficient Regeneration after Partial Hepatectomy in a Porcine Model

Petru O. Bucur, Mohamed Bekheit, Chloe Audebert, Amnah Othman, Seddik Hammad, Mylene Sebagh, Marc Antoine Allard, Benoît Decante, Adrian Friebel, Elodie Miquelestorena-Standley, Dirk Drasdo, Jan G. Hengstler, Irene E. Vignon-Clementel, Eric Vibert*

*Corresponding author for this work

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)134-142
Number of pages9
JournalAnnals of Surgery
Volume268
Issue number1
DOIs
Publication statusPublished - Jul 2018

Fingerprint

Hepatectomy
Blood Vessels
Regeneration
Swine
Hemodynamics
montirelin
Liver Failure
Bile Canaliculi
Liver Regeneration
Liver
Economic Inflation
Portal Vein
Bilirubin
Safety
Pressure
Control Groups
Mortality
Serum

Keywords

  • liver regeneration
  • liver resection
  • portal flow modulation
  • posthepatectomy failure
  • small-for-size
  • vascular ring

ASJC Scopus subject areas

  • Surgery

Cite this

Modulating Portal Hemodynamics with Vascular Ring Allows Efficient Regeneration after Partial Hepatectomy in a Porcine Model. / Bucur, Petru O.; Bekheit, Mohamed; Audebert, Chloe; Othman, Amnah; Hammad, Seddik; Sebagh, Mylene; Allard, Marc Antoine; Decante, Benoît; Friebel, Adrian; Miquelestorena-Standley, Elodie; Drasdo, Dirk; Hengstler, Jan G.; Vignon-Clementel, Irene E.; Vibert, Eric.

In: Annals of Surgery, Vol. 268, No. 1, 07.2018, p. 134-142.

Research output: Contribution to journalArticle

Bucur, PO, Bekheit, M, Audebert, C, Othman, A, Hammad, S, Sebagh, M, Allard, MA, Decante, B, Friebel, A, Miquelestorena-Standley, E, Drasdo, D, Hengstler, JG, Vignon-Clementel, IE & Vibert, E 2018, 'Modulating Portal Hemodynamics with Vascular Ring Allows Efficient Regeneration after Partial Hepatectomy in a Porcine Model', Annals of Surgery, vol. 268, no. 1, pp. 134-142. https://doi.org/10.1097/SLA.0000000000002146
Bucur, Petru O. ; Bekheit, Mohamed ; Audebert, Chloe ; Othman, Amnah ; Hammad, Seddik ; Sebagh, Mylene ; Allard, Marc Antoine ; Decante, Benoît ; Friebel, Adrian ; Miquelestorena-Standley, Elodie ; Drasdo, Dirk ; Hengstler, Jan G. ; Vignon-Clementel, Irene E. ; Vibert, Eric. / Modulating Portal Hemodynamics with Vascular Ring Allows Efficient Regeneration after Partial Hepatectomy in a Porcine Model. In: Annals of Surgery. 2018 ; Vol. 268, No. 1. pp. 134-142.
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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.",
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author = "Bucur, {Petru O.} and Mohamed Bekheit and Chloe Audebert and Amnah Othman and Seddik Hammad and Mylene Sebagh and Allard, {Marc Antoine} and Beno{\^i}t Decante and Adrian Friebel and Elodie Miquelestorena-Standley and Dirk Drasdo and Hengstler, {Jan G.} and Vignon-Clementel, {Irene E.} and Eric Vibert",
note = "This study was funded mainly by the “Agence de la Biomedecine” through its program of Research (AOR 2009) and Soci{\'e}t{\'e} Francophone de la Transplantation (Bourse IGL 2009). E.V., I.V.-C., D.D., P.O.B., M.B., C.A., and J.H. acknowledge funding by project ANR-13-TECS-0006 (IFlow), Adrian Friebel by Virtual Liver Network (German Bundesministerium f{\"u}r Bildung und Forschung [BMBF]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).",
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AU - Bucur, Petru O.

AU - Bekheit, Mohamed

AU - Audebert, Chloe

AU - Othman, Amnah

AU - Hammad, Seddik

AU - Sebagh, Mylene

AU - Allard, Marc Antoine

AU - Decante, Benoît

AU - Friebel, Adrian

AU - Miquelestorena-Standley, Elodie

AU - Drasdo, Dirk

AU - Hengstler, Jan G.

AU - Vignon-Clementel, Irene E.

AU - Vibert, Eric

N1 - This study was funded mainly by the “Agence de la Biomedecine” through its program of Research (AOR 2009) and Société Francophone de la Transplantation (Bourse IGL 2009). E.V., I.V.-C., D.D., P.O.B., M.B., C.A., and J.H. acknowledge funding by project ANR-13-TECS-0006 (IFlow), Adrian Friebel by Virtual Liver Network (German Bundesministerium für Bildung und Forschung [BMBF]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

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N2 - 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.

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