Pulmonary Edema After Transjugular Intrahepatic Portosystemic Shunt

Willoughby, Paul H.; Beers, Richard A.; Murphy, Kenneth D.

doi:10.1213/00000539-199604000-00066

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Lastly, an overflow of the portal vein with a reduction in the splanchnic venous tension can compromise the patient's ability to undergo LT successfully. Portal overflow alone can cause pulmonary oedema and acute pulmonary hypertension, such as after the placement of a transjugular intrahepatic portosystemic shunt, even in the absence of evident heart disease [26]. Another life-threatening hemodynamic change is the post-reperfusion syndrome, defined as severe hypotension requiring vasopressor infusion associated with hemodynamically significant arrhythmias (incidence 4 and 81%, respectively), which is also correlated to an acute decrease in SVR or ventricular dysfunction due to ischemiareperfusion injury [27].…”

Section: Discussionmentioning

confidence: 99%

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies—Case Reports and Literature Review

Laici

Bianchini

Miglionico

et al. 2023

JCM

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Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT.

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Section: Discussionmentioning

confidence: 99%

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies—Case Reports and Literature Review

Laici

Bianchini

Miglionico

et al. 2023

JCM

View full text Add to dashboard Cite

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Predictors of mortality after transjugular portosystemic shunt

Ascha

Abuqayyas

Hanouneh

et al. 2016

WJH

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AIM:To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt (TIPS) can provide prognostic information that will enhance risk Predictors of mortality after transjugular portosystemic shunt Retrospective Study ORIGINAL ARTICLEstratification of patients. METHODS:We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution. We recorded information regarding patient demographics, underlying liver disease, indication for TIPS, baseline laboratory values, hemodynamic determinations at the time of TIPS, and echocardiographic measurements both before and after TIPS. We recorded patient comorbidities that may affect hemodynamic and echocardiographic determinations. We also calculated Model for Endstage Liver Disease (MELD) score and Child Turcotte Pugh (CTP) class. The following pre-and post-TIPS echocardiographic determinations were recorded: Left ventricular ejection fraction, right ventricular (RV) systolic pressure, subjective RV dilation, and subjective RV function. We recorded the following hemodynamic measurements: Right atrial (RA) pressure before and after TIPS, inferior vena cava pressure before and after TIPS, free hepatic vein pressure, portal vein pressure before and after TIPS, and hepatic venous pressure gradient (HVPG). RESULTS:We reviewed 418 patients with portal hypertension undergoing TIPS. RA pressure increased by a mean ± SD of 4.8 ± 3.9 mmHg (P < 0.001), HVPG decreased by 6.8 ± 3.5 mmHg (P < 0.001). In multivariate linear regression analysis, a higher MELD score, lower platelet count, splenectomy and a higher portal vein pressure were independent predictors of higher RA pressure (R = 0.55). Three variables predicted 3-mo mortality after TIPS in a multivariate analysis: Age, MELD score, and CTP grade C. Change in the RA pressure after TIPS predicted long-term mortality (per 1 mmHg change, HR = 1.03, 95%CI: 1.01-1.06, P < 0.012). CONCLUSION:RA pressure increased immediately after TIPS particularly in patients with worse liver function, portal hypertension, emergent TIPS placement and history of splenectomy. The increase in RA pressure after TIPS was associated with increased mortality. Age, splenectomy, MELD score and CTP grade were independent predictors of long-term mortality after TIPS. Core tip: Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure accompanied by morbidity and mortality. We hypothesize that echocardiographic and hemodynamic determinations obtained at the time of TIPS can provide prognostic information that will enhance risk stratification of patients. We measured echocardiographic and hemodynamic variables before and immediately after the TIPS procedure in a large cohort of patients at our institution. Our findings corroborate previous literature stating that right atrial pressure increased after TIPS. Our study demonstrates several predictors of long-term mortality after TIPS, such as age, splenectomy, and Model for End-s...

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Pulmonary Edema After Transjugular Intrahepatic Portosystemic Shunt

Cited by 2 publications

References 3 publications

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies—Case Reports and Literature Review

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies—Case Reports and Literature Review

Predictors of mortality after transjugular portosystemic shunt

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