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

10 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

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Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Bucur, P. O., Bekheit, M., Audebert, C., Othman, A., Hammad, S., Sebagh, M., Allard, M. A., Decante, B., Friebel, A., Miquelestorena-Standley, E., Drasdo, D., Hengstler, J. G., Vignon-Clementel, I. E., & Vibert, E. (2018). Modulating Portal Hemodynamics with Vascular Ring Allows Efficient Regeneration after Partial Hepatectomy in a Porcine Model. Annals of Surgery, 268(1), 134-142. https://doi.org/10.1097/SLA.0000000000002146