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<p>Hepatic inflow occlusion is central to major hepatobiliary surgery, but its association with early postoperative myocardial injury remains uncertain. We evaluated whether selective portal vein occlusion (SPVO), which preserves hepatic arterial flow, was associated with myocardial injury after noncardiac surgery (MINS) compared with the Pringle maneuver. This multicenter retrospective-prospective observational cohort included 1,286 adults aged 45 to 85 years undergoing major hepatobiliary surgery with paired perioperative high-sensitivity cardiac troponin T data (Pringle, <i>n</i> = 884; SPVO, <i>n</i> = 402). The primary outcome was early postoperative MINS within postoperative days 0 to 3, adjudicated using prespecified hs-cTnT criteria and ischemic-origin review. Propensity-score overlap weighting was the primary adjustment strategy, with stabilized IPTW as an auxiliary analysis and strict matching as a sensitivity analysis. Early postoperative MINS occurred in 214 Pringle patients (24.2%) and 68 SPVO patients (16.9%). In the primary overlap-weighted analysis, SPVO was directionally but not statistically significantly associated with lower odds of early postoperative MINS (odds ratio, 0.682; 95% CI, 0.448 to 1.038; <i>P</i> = 0.074). The auxiliary IPTW estimate was similar but imprecise. These hypothesis-generating findings require prospective validation.</p><p><b>Trial registration:</b> This observational cohort study was registered at ClinicalTrials.gov (NCT06895798, first posted March 26, 2025). The registry start date reflects retrospective screening, feasibility review, and study-database preparation using previously generated clinical records rather than prospective participant enrollment. Prospective consent, biospecimen collection, and scheduled research hs-cTnT measurements began only after ethics approval and public registry posting. Because part of the retrospective data assembly preceded registry posting and treatment allocation was not randomized, the study is presented as a retrospective-prospective observational cohort. </p>

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Selective portal vein occlusion and myocardial injury after major hepatobiliary surgery: a propensity-weighted cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • Yi Duan,
  • Zheng Zhang,
  • Jinyan Wei,
  • Qinzheng Wen,
  • Lin Ding,
  • Yuze Wang,
  • Qian Lu,
  • Zhifeng Gao

摘要

Hepatic inflow occlusion is central to major hepatobiliary surgery, but its association with early postoperative myocardial injury remains uncertain. We evaluated whether selective portal vein occlusion (SPVO), which preserves hepatic arterial flow, was associated with myocardial injury after noncardiac surgery (MINS) compared with the Pringle maneuver. This multicenter retrospective-prospective observational cohort included 1,286 adults aged 45 to 85 years undergoing major hepatobiliary surgery with paired perioperative high-sensitivity cardiac troponin T data (Pringle, n = 884; SPVO, n = 402). The primary outcome was early postoperative MINS within postoperative days 0 to 3, adjudicated using prespecified hs-cTnT criteria and ischemic-origin review. Propensity-score overlap weighting was the primary adjustment strategy, with stabilized IPTW as an auxiliary analysis and strict matching as a sensitivity analysis. Early postoperative MINS occurred in 214 Pringle patients (24.2%) and 68 SPVO patients (16.9%). In the primary overlap-weighted analysis, SPVO was directionally but not statistically significantly associated with lower odds of early postoperative MINS (odds ratio, 0.682; 95% CI, 0.448 to 1.038; P = 0.074). The auxiliary IPTW estimate was similar but imprecise. These hypothesis-generating findings require prospective validation.

Trial registration: This observational cohort study was registered at ClinicalTrials.gov (NCT06895798, first posted March 26, 2025). The registry start date reflects retrospective screening, feasibility review, and study-database preparation using previously generated clinical records rather than prospective participant enrollment. Prospective consent, biospecimen collection, and scheduled research hs-cTnT measurements began only after ethics approval and public registry posting. Because part of the retrospective data assembly preceded registry posting and treatment allocation was not randomized, the study is presented as a retrospective-prospective observational cohort.