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

We evaluated haemodynamic changes during major liver resection that involve d total hepatic vascular exclusion (HVE) carried out through clamping hepat ic pedicle and inferior caval vein upper and above the liver. Fourteen pati ents, undergoing different procedures of major liver resection, were enroll ed in this study which used complete cardiovascular monitoring. Haemodynami c parameters were measured and calculated at five different times during th e operation. Changes such as reduction in cardiac output and increase in sy stemic vascular resistance, though significant, were well tolerated in all patients, allowing the execution of major liver surgery. HVE offers a signi ficant reduction in haemorrhagic and air embolus risk, but it requires the use of complete haemodynamic monitoring to evaluate tolerance to clamping a nd correction of unavoidable cardiovascular changes.