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. 2023 Nov 30;13(12):1007.
doi: 10.3390/bios13121007.

Development of a Direct Non-Puncture Device for Measuring Portal Venous Pressure during Liver Transplantation-A Swine Model

Kung-Chen Ho  1   2   3 , Tun-Sung Huang  2   3 , Jiunn-Chang Lin  2   3   4   5 , Huihua Kenny Chiang  1
Affiliations

Development of a Direct Non-Puncture Device for Measuring Portal Venous Pressure during Liver Transplantation-A Swine Model

Kung-Chen Ho et al. Biosensors (Basel). .

Abstract

Portal hypertension-related complications pose a significant risk for liver failure post-transplantation. Thus, accurate monitoring of intraoperative portal venous pressure (PVP) is crucial. However, current PVP monitoring techniques requiring direct percutaneous puncture carry the risk of graft damage. In this study, we present an innovative non-puncture PVP monitoring device (PVPMD) using a 3D-printed prototype. PVPMD design is inspired by the sphygmomanometer principle, and strategically encompasses the portal vein and enables precise PVP measurement through blood flow ultrasonography after temporary occlusion. By a series of mini-pig experiments, the prototype PVPMD demonstrated a strong correlation with invasive catheter measurements in the main trunk of the portal vein (rs = 0.923, p = 0.000). There was a significant repeatability and reproducibility between the prototype PVPMD- and invasive catheter-measured PVP. This indicates that the PVPMD holds immense potential for direct application in liver transplantation and surgery. Moreover, it has the potential to replace catheter-based central venous pressure (CVP) measurements, thereby mitigating catheter-related complications during many surgeries. In conclusion, our innovative device represents a significant advancement in PVP monitoring during liver transplantation, with comprehensive validation from principle exploration to successful animal experiments. We anticipate that this groundbreaking PVPMD will attract the attention of researchers and clinicians, propelling the noninvasive measurement of PVP or other venous/arterial pressures into a new era of clinical practice.

Keywords: liver transplantation; non-puncture PVP measuring device; portal vein pressure; swine.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Illustration of the surgical anatomy during liver transplantation. We used this space (white arrow under the portal vein) to design the corresponding device. (b–d) Simulation of the prototype PVPMD using 3D modeling software, with the corresponding 3D–printed components produced by a 3D Printer UP Mini 2. (b) The support base of the PVPMD can be inserted into the space beneath the portal vein; (c) The plastic portion of the adjustable bag sleeve was mounted on the support base; and (d) the adjustable bag sleeve can be inflated and deflated via an outer plastic tube (black arrow).
Figure 2
Figure 2
In the hepatic portal system, blood from the capillary beds of the small and large intestines, spleen, pancreas, and stomach is diverted to the liver by the hepatic portal vein before entering the posterior vena cava and returning to the heart. This anatomical drawing was a modified version of an image from the 3rd edition of A Dissection Guide Atlas to the Fetal Pig [21].
Figure 3
Figure 3
System overview. A medical syringe was used to inflate and deflate the bag of the PVPMD via an inflation tube. The pressure detector with a pressure detection panel was connected to a small plastic tube that branched off the inflation tube. The ultrasound probe of the Doppler flow probe, was placed in direct contact with the portal vein. The blood flow signal can be read on the screen of the flowmeter, which emits an audible signal in response to the blood flow.
Figure 4
Figure 4
Photographs showing the use of the PVPMD during surgery. (a) The support base of the PVPMD is inserted into the space under the portal vein. In (b,c), an adjustable bag sleeve is mounted onto the support base. (d) During the measurements, the Doppler flow probe was placed in contact with the portal vein close to the device to assist in the measurement of the PVP.
Figure 5
Figure 5
Correlations and agreements between the pressure values obtained using the PVPMD and the catheter were placed on the main trunk of the portal vein. (a) Spearman’s correlation (b) Bland–Altman agreement.
Figure 6
Figure 6
Correlations and agreements between the pressure values obtained using the PVPMD were placed on the main trunk of the portal vein and a catheter located in the distal mesenteric vein. (a) Spearman’s correlation. (b) Bland–Altman agreement.
Figure 7
Figure 7
Correlations and agreements between the pressure values obtained using the PVPMD were placed on the main trunk of the portal vein and a catheter located in the intrahepatic part of the portal vein. (a) Spearman’s correlation. (b) Bland–Altman agreement.
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