SURGICAL APPROACH FOR MAINTAINING NONISCHEMIC CONDITIONS OF THE LIVERIN ACUTE HEPATIC VEIN OBSTRUCTION

To establish a possible surgical approach for preventing warm ischemic injury to the liver followed by hepatic vein occlusion (HVO), the hep atic hemodynamics and energy metabolism were investigated in an acute canine HVO model with and without hepatic arterial blood flow. Arteria l blood ketone body ratio (AKBR; acetoacetate/3-hydroxybutyrate) and a denylate energy charge potential (ECP = [ATP + 1/2 ADP]/[ATP + ADP + A MP]) of the liver tissue were measured during and after 60 min of HVO. In the group with hepatic arterial blood flow, in which arterial bloo d was drained by hepatofugal portal flow via the venovenous bypass, to tal hepatic blood flow, portal vein pressure, ECP, and AKBR were maint ained at almost normal level after the termination of HVO, resulting i n the survival of all animals for 3 days or longer. By contrast, in th e group without hepatic arterial blood flow (warm ischemic group), tot al hepatic blood flow was maintained at less than 60% of preischemic v alue, and portal vein pressure gradually increased up to twice the pre ischemic value. ECP decreased from 0.81 +/- 0.06 to 0.71 +/- 0.07 alon g with increasing portal venous pressure, and AKBR also decreased from 1.23 +/- 0.12 to 0.63 +/- 0.23, resulting in no survival longer 6 hr. It was concluded that hepatic arterial blood flow during HVO, if drai ned as hepatofugal portal flow, could maintain nonischemic conditions in the liver, despite vena cava obstruction, by providing an alternate outflow via reversed flow in the portal vein. (C) 1995 Academic Press , Inc.