Pulmonary Edema After Transjugular Intrahepatic Portosystemic Shunt

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

doi:10.1097/00000539-199604000-00066

Cited by 3 publications

(2 citation statements)

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“…Patients with advanced cirrhosis and portal hypertension can develop cardiomyopathy with left ventricular diastolic dysfunction [21] , hyperdynamic state, volume overload, and less commonly portopulmonary hypertension; these conditions can be aggravated with the insertion of TIPS [14,17,[22][23][24] . The placement of TIPS rapidly increases the RV preload and afterload, which can lead to overt heart failure, pulmonary hypertension and death [11,14,16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] . RA pressure obtained before TIPS could be of value in clinical practice; physicians may elect to abort a TIPS procedure based on this hemodynamic parameter.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Predictors of mortality after transjugular portosystemic shunt

Ascha

Abuqayyas

Hanouneh

et al. 2016

WJH

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“…Thus, the effects of TIPS on the pulmonary circulation depend on the dynamic interaction of the changes in venous return, effective circulating volume, systemic vascular resistance, and myocardial reserve. The varying outcomes of patients with cirrhotic pulmonary hypertension and hepatopulmonary syndrome after TIPS are due to the varying outcomes of the interactions between these variables [91,92]. Because the outcome is not predictable and may actually worsen the clinical condition, TIPS are not indicated for these conditions.…”

Section: Livermentioning

confidence: 99%

The use and misuse of transjugular intrahepatic portasystemic shunts

Sanyal

2000

Curr Gastroenterol Rep

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Transjugular intrahepatic portasystemic shunts, or TIPS, are used to create a low-resistance channel between the hepatic vein and the intrahepatic portion of the portal vein by deployment of an expandable metal stent. TIPS function like side-to-side surgical portacaval shunts, but their placement does not require anesthesia and major surgery. This article reviews the uses and misuses of TIPS in current practice. The uses include variceal hemorrhage and ascites as well as miscellaneous indications such as Budd-Chiari syndrome, veno-occlusive disease, bleeding ectopic and rectal varices, hepatic hydrothorax, and portal hypertensive gastropathy. TIPS is not indicated for primary prophylaxis of variceal hemorrhage, prehepatic portal hypertension, correction of hypersplenism and thrombocytopenia, pulmonary hypertension and hepatopulmonary syndrome, and portal hypertension associated with polycystic liver disease or Caroli's disease. Also reviewed herein is the management of patients after TIPS placement.

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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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Pulmonary Edema After Transjugular Intrahepatic Portosystemic Shunt

Cited by 3 publications

References 3 publications

Predictors of mortality after transjugular portosystemic shunt

Predictors of mortality after transjugular portosystemic shunt

The use and misuse of transjugular intrahepatic portasystemic shunts

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

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