Annals of Surgical Oncology

, Volume 21, Issue 2, pp 473–478 | Cite as

Stroke Volume Variation in Hepatic Resection: A Replacement for Standard Central Venous Pressure Monitoring

  • Erik M. Dunki-Jacobs
  • Prejesh Philips
  • Charles R. Scoggins
  • Kelly M. McMasters
  • Robert C. G. MartinIIEmail author
Hepatobiliary Tumors



Central venous pressure (CVP) is the standard method of volume status evaluation during hepatic resection. CVP monitoring requires preoperative placement of a central venous catheter (CVC), which can be associated with increased time, cost, and adverse events. Stroke volume variation (SVV) is a preload index that can be used to predict an individual’s fluid responsiveness through an existing arterial line. The purpose of this study was to determine if SVV is as safe and effective as CVP in measuring volume status during hepatic resection.


Two cohorts of 40 consecutive patients (80 total) were evaluated during hepatic resection between December 2010 and August 2012. The initial evaluation group of 40 patients had continuous CVP monitoring and SVV monitoring performed simultaneously to establish appropriate SVV parameters for hepatic resection. A validation group of 40 patients was then monitored with SVV alone to confirm the accuracy of the established SVV parameters. Type of hepatic resection, transection time, blood loss, complications, and additional operative and postoperative factors were collected prospectively. SVV was calculated using the Flotrac™/Vigileo™ System.


The evaluation group included 40 patients [median age 62 (29–82) years; median body mass index (BMI) 27.7 (16.5–40.6)] with 18 laparoscopic, 22 open, and 24 undergoing major (≥3 segments) hepatectomy. Median transection times were 43 (range 20–65) min, median blood loss 250 (range 20–950) cc, with no Pringle maneuver utilized. In this evaluation group, a CVP of −1 to 1 significantly correlated to a SVV of 18–21 (R 2 = 0.85, p < 0.001). The validation group included 40 patients [median age 61 (35–78) years; median BMI 28.1 (17–41.2)], with 24 laparoscopic, 16 open, and 33 undergoing major hepatectomy. Using a SVV goal of 18 to 21, median transection time was 55 (25–78) min, median blood loss of 255 (range 100–1,150) cc, again without the use of a Pringle maneuver.


SVV can be used safely as an alternative to CVP monitoring during hepatic resection with equivalent outcomes in terms of blood loss and parenchymal transection time. Using SVV as a predictor of fluid status could prove to be advantageous by avoiding the need for CVC insertion and therefor eliminating the risk of CVC related complications in patients undergoing hepatic resection.


Hepatic Resection Central Venous Catheter Central Venous Pressure Stroke Volume Variation Laparoscopic Hepatectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no financial disclosures to make.


  1. 1.
    Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995;19(1):59–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Yanaga K, Kanematsu T, Takenaka K, Matsumata T, Yoshida Y, Sugimachi K. Hepatic resection for hepatocellular carcinoma in elderly patients. Am J Surg. 1988;155(2):238–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Nagao T, Inoue S, Goto S, Mizuta T, Omori Y, Kawano N, et al. Hepatic resection for hepatocellular carcinoma. Clinical features and long-term prognosis. Ann Surg. 1987;205(1):33–40.PubMedCrossRefGoogle Scholar
  4. 4.
    Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85(8):1058–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187(6):620–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC. The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg. 2004;187(3):398–402.PubMedCrossRefGoogle Scholar
  7. 7.
    Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg. 2007;204(4):681–96.PubMedCrossRefGoogle Scholar
  8. 8.
    Burns KE, McLaren A. A critical review of thromboembolic complications associated with central venous catheters. Can J Anaesth. 2008;55(8):532–41.PubMedCrossRefGoogle Scholar
  9. 9.
    Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care. 2005;9(6):R631–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Cevasco M, Borzecki AM, O’Brien WJ, Chen Q, Shin MH, Itani KM, et al. Validity of the AHRQ Patient Safety Indicator “central venous catheter-related bloodstream infections.” J Am Coll Surg. 2011;212(6):984–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Benes J, Chytra I, Altmann P, Hluchy M, Kasal E, Svitak R,, et al. Intraoperative fluid optimization using stroke volume variation in high risk surgical patients: results of prospective randomized study. Crit Care. 2010;14(3):R118.PubMedCrossRefGoogle Scholar
  12. 12.
    Hofer CK, Senn A, Weibel L, Zollinger A. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system. Crit Care. 2008;12(3):R82.PubMedCrossRefGoogle Scholar
  13. 13.
    McGee, W.T., A simple physiologic algorithm for managing hemodynamics using stroke volume and stroke volume variation: physiologic optimization program. J Intensive Care Med. 2009;24(6):352–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Bower MR, Ellis SF, Scoggins CR, McMasters KM, Martin RC. Phase II comparison study of intraoperative autotransfusion for major oncologic procedures. Ann Surg Oncol. 2011;18(1):166–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Brown RE, Bower MR, Metzger TL, Scoggins CR, McMasters KM, Hahl MJ, et al. Hepatectomy after hepatic arterial therapy with either yttrium-90 or drug-eluting bead chemotherapy: is it safe? HPB (Oxford). 2011;13(2):91–5.CrossRefGoogle Scholar
  16. 16.
    Martin RC, Scoggins CR, McMasters KM. Laparoscopic hepatic lobectomy: advantages of a minimally invasive approach. J Am Coll Surg. 2010;210(5):627–6.CrossRefGoogle Scholar
  17. 17.
    Mbah NA, Brown RE, Bower MR, Scoggins CR, McMasters KM, Martin RC. Differences between bipolar compression and ultrasonic devices for parenchymal transection during laparoscopic liver resection. HPB (Oxford). 2012;14(2):126–31.CrossRefGoogle Scholar
  18. 18.
    Cannon RM, Martin RC, Callender GG, McMasters KM, Scoggins CR. Safety and efficacy of hepatectomy for colorectal metastases in the elderly. J Surg Oncol. 2011;104(7):804–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Cannon RM, Scoggins CR, Callender GG, McMasters KM, Martin RC 2nd. Laparoscopic versus open resection of hepatic colorectal metastases. Surgery. 2012;152(4):567–73; discussion 573–4.Google Scholar
  20. 20.
    Marx G, Cope T, McCrossan L, Swaraj S, Cowan C, Mostafa SM, et al. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis. Eur J Anaesthesiol. 2004;21(2):132–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Zhang HM, Liu DW, Wang XT, Rui X, Wang H, He HW, et al. Stroke volume variation in the evaluation of fluid responsiveness in refractory septic shock. Zhonghua Nei Ke Za Zhi. 2010;49(7):610–3.PubMedGoogle Scholar
  22. 22.
    Zhang Z, Lu B, Sheng X, Jin N. Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis. J Anesth. 2011;25(6):904–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92(4):984–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Jain AK, Dutta A. Stroke volume variation as a guide to fluid administration in morbidly obese patients undergoing laparoscopic bariatric surgery. Obes Surg. 2010;20(6):709–15.PubMedCrossRefGoogle Scholar
  25. 25.
    Li C, Lin FQ, Fu SK, Chen GQ, Yang XH, Zhu CY, et al. Stroke volume variation for prediction of fluid responsiveness in patients undergoing gastrointestinal surgery. Int J Med Sci. 2013;10(2):148–55.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lee JY, Park HY, Jung WS, Jo YY, Kwak HJ. Comparative study of pressure- and volume-controlled ventilation on stroke volume variation as a predictor of fluid responsiveness in patients undergoing major abdominal surgery. J Crit Care. 2012;27(5):531 e9–14.PubMedCrossRefGoogle Scholar
  27. 27.
    Derichard A, Robin E, Tavernier B, Costecalde M, Fleyfel M, Onimus J, et al. Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery. Br J Anaesth. 2009;103(5):678–84.PubMedCrossRefGoogle Scholar
  28. 28.
    Shin YH, Ko JS, Gwak MS, Kim GS, Lee JH, Lee SK. Utility of uncalibrated femoral stroke volume variation as a predictor of fluid responsiveness during the anhepatic phase of liver transplantation. Liver Transpl. 2011;17(1):53–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Su BC, Tsai YF, Cheng CW, Yu HP, Yang MW, Lee WC, et al. Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation. Transplant Proc. 2012;44(2):429–32.PubMedCrossRefGoogle Scholar
  30. 30.
    Kim YK, Shin WJ, Song JG, Jun IG, Hwang GS. Does stroke volume variation predict intraoperative blood loss in living right donor hepatectomy? Transplant Proc. 2011;43(5):1407–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care. 2002;6(3):199–204.PubMedCrossRefGoogle Scholar
  32. 32.
    Kim SH, Park SY, Cui J, Lee JH, Cho SH, Chae WS, et al. Peripheral venous pressure as an alternative to central venous pressure in patients undergoing laparoscopic colorectal surgery. Br J Anaesth. 2011;106(3):305–11.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Erik M. Dunki-Jacobs
    • 1
  • Prejesh Philips
    • 1
  • Charles R. Scoggins
    • 1
  • Kelly M. McMasters
    • 1
  • Robert C. G. MartinII
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA

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