Predicting Heart Failure After TIPS: Still More Questions Than Answers

Baiges, Anna; García‐Pagán, Juan Carlos

doi:10.1002/hep.30948

Cited by 5 publications

(5 citation statements)

References 11 publications

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Section: Postprocedural Complicationsmentioning

confidence: 99%

“…The large-volume blood shift from the splanchnic to the systemic circulation results in a sudden but mostly transitory increase in right heart pressures and cardiac output. 59,60 The cardiac output increases by 22%, systemic vascular resistance decreases by 26%, the right atrial pressure (RAP) may increase by 50%, and mean pulmonary artery pressure (mPAP) by 40%. 61 TIPS is contraindicated in patients with right heart failure and severe pulmonary hypertension, defined as mPAP > 45 mm Hg at right heart catheterization and pulmonary capillary wedged pressure (PCWP) 15 mm Hg or systolic PAP > 50 mm Hg at echocardiography.…”

Section: Renal Function Complicationsmentioning

confidence: 99%

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A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Lopera

2023

Semin intervent Radiol

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Transjugular intrahepatic portosystemic shunt (TIPS) is one of the most technically complex procedures in interventional radiology, the need to connect two veins with variable anatomy, located in two different planes in hard and many times small cirrhotic livers using a needle, can be quite challenging. Despite more than 30 years of performing TIPS, the complex hemodynamics of the portal system are not fully understood, and sometimes unpredictable alterations of the portal flow can lead to serious unexpected complications. The best strategies to prevent TIPS complications are optimal patient selection, meticulous technique, operator experience, and immediate correction of identified adverse events. The purpose of this article is to review the technical complications with TIPS, the unique complications related to the use of stent grafts, and the late complications after the procedure, with emphasis on ways to prevent and treat them.

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Section: Postprocedural Complicationsmentioning

confidence: 99%

Section: Renal Function Complicationsmentioning

confidence: 99%

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Lopera

2023

Semin intervent Radiol

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“…Historically, utilization of TIPS therapy has been limited by stent dysfunction. 29 Improved manufacturing and risk prediction algorithms have improved clinical outcomes, but TIPS related cardiovascular complications remain. Post-TIPS cardiac failure is poorly understood.…”

Section: Assessing Cardiovascular Decompensation Risk After Tips Tips...mentioning

confidence: 99%

“…This generated disagreement among investigators, highlighted by an editorial by Baiges et al This group argues that while the significant trend seen in patients with aortic stenosis was concerning, the small sample size and event rate is insufficient to recommend aortic stenosis as an absolute contraindication to TIPS. 29 Furthermore, the authors argue the study by Billey et al provides more questions than answers, and caution integration into clinical best practice before larger, prospective studies validate their proposals.…”

Section: Assessing Cardiovascular Decompensation Risk After Tipsmentioning

confidence: 99%

Cardiovascular Considerations in Patients with Liver Cirrhosis

Vogt

Chu

2022

Digestive Disease Interventions

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Liver cirrhosis is a significant cause of morbidity and mortality and can result in alterations to cardiac function. Patients with cirrhosis may develop a hyperdynamic circulation. Furthermore, systolic or diastolic function may occur, although diastolic function is more common. The transjugular intraheptic portosystemic shunt (TIPS) is an increasingly prominent procedure to treat portal hypertension that can result in transient worsening of hyperdynamic circulation. TIPS can be complicated by cardiac decompensation, with diastolic dysfunction playing a key role. Investigators developed an algorithm to stratify risk of cardiac decompensation after TIPS using natriuretic peptide levels and echocardiography. Eighty percent of patients with aortic stenosis decompensated after TIPS in one cohort, but this requires further study before it is considered a contraindication. Cirrhosis has also been linked to development of atrial fibrillation, although data remain mixed. The first-choice anticoagulant should be direct oral anticoagulants, as studies show superior outcomes to warfarin. QTc prolongation is often seen in patients with cirrhosis, theoretically predisposing to ventricular arrhythmias, however the clinical significance remains unclear. The impact of TIPS on arrhythmia is understudied, but small cohorts found high rates. Overall, cirrhosis can have significant impacts of cardiac function and clinicians must be aware of these alterations.

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“…Une insuffisance cardiaque postTIPS pourrait être observée chez environ 10 % des patients. 30 Avant mise en place d'un TIPS, une étude de la fonction cardiaque, par échocardiographie et parfois cathétérisme cardiaque droit, est donc requise. 14 Toutes les études citées dans cette revue ont exclu les patients présentant une pathologie cardiaque significative.…”

Section: Quid Des Patients Aux Limites ?unclassified

Early TIPS : une revue pratique après 15 ans d’évidence scientifique

Shams¹,

Moschouri²,

Denys³

et al. 2020

Revue Médicale Suisse

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Les patients hospitalisés pour hémorragie digestive sur hypertension portale ont un risque élevé de mortalité (10-20%). La création d'un shunt portosystémique par voie transjugulaire (TIPS) permet de diminuer le gradient de pression entre le système porte et la circulation systémique (gradient portosystémique) réduisant ainsi le risque hémorragique. Chez des patients sélectionnés à haut risque de non-contrôle et/ou de récidive hémorragique, plusieurs études ont évalué l'intérêt de l'insertion précoce d'un TIPS (early TIPS) dans les 72 heures suivant l'endoscopie diagnostique. Elles observent en majorité une amélioration de la survie à 6 semaines et 1 an et une diminution du non-contrôle ou de la récidive hémorragique. Nous proposons ici une revue des études disponibles et discutons des limites de cette stratégie en termes d'accessibilité à la technique et d'identification des patients nécessitant encore régulièrement une discussion collégiale au cas par cas. Early TIPS: a practical review after 15 years of scientific evidenceGastrointestinal bleeding related to portal hypertension of cirrhosis is associated with a significant mortality risk (10-20 %). The transjugular intrahepatic portosystemic shunt (TIPS) reduces the hepatic venous pressure gradient. Several studies have evaluated early TIPS insertion (within 72h from diagnostic endoscopy) with the aim of improving outcomes in selected patients at high risk of failure to control bleeding and/or rebleeding. The majority reported an improvement of 6-week and 1-year survival rates and a decrease in failure to control bleeding and rebleeding. Here, we review the available data and discuss the limits of early TIPS in terms of patient identification and access to the procedure.

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Predicting Heart Failure After TIPS: Still More Questions Than Answers

Cited by 5 publications

References 11 publications

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

A Comprehensive Review of Transjugular Intrahepatic Portosystemic Shunt–Related Complications

Cardiovascular Considerations in Patients with Liver Cirrhosis

Early TIPS : une revue pratique après 15 ans d’évidence scientifique

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