Transjugular Intrahepatic Portosystemic Shunt prior to Cardiac Surgery with Cardiopulmonary Bypass in Patients with Cirrhosis and Portal Hypertension

Consensus conference on TIPS management: Techniques, indications, contraindications

“…A number of risk factors for hepatic decompensation following cardiac surgery have been identified including the total time of cardiopulmonary bypass, use of non-pulsatile as opposed to pulsatile cardiopulmonary bypass, and need for perioperative pressor support [218]. Cardiopulmonary by-pass can exacerbate underlying coagulopathy by inducing platelet dysfunction, fibrinolysis, and hypocalcaemia.…”

“…TIPS might be considered before cardiac surgery in selected patients with portal hypertension. However, the role of preoperative TIPS has not been well studied in this context, where TIPS placement is strongly affected by the heart conditions: a careful multidisciplinary evaluation is warranted before opting for TIPS (5;D) [218,219].…”

Surgery in the Patient with Liver Disease

“…Portal decompression with TIPS placement may make the risk acceptable if the CTP and MELD scores remain low (29); however, elevated right-sided cardiac pressures from cardiac dysfunction and pulmonary hypertension are absolute contraindications to TIPS placement.…”

Cirrhotic Patients With a Transjugular Intrahepatic Portosystemic Shunt Undergoing Major Extrahepatic Surgery

“…Using the ICD-9-CM discharge diagnosis codes for various major abdominal and cardiothoracic surgeries (excluding liver transplantation), 25 subjects with a TIPS were identified who had undergone a TIPS procedure before surgery including 2 subjects previously reported. 15 In 19 patients, the TIPS had been placed previously for refractory ascites or bleeding varices, whereas in 6 patients, the TIPS was placed specifically for the purpose of portal decompression before planned surgery. Medical records including laboratory values, radiology reports, operative reports, and blood blank data were reviewed and abstracted into an excel database.…”

“…12,13 Portal decompression via TIPS placement can potentially reduce the risk of intraoperative bleeding and perioperative complications in patients with cirrhosis undergoing surgery but experience is limited. [14][15][16][17][18][19][20][21] The primary aim of this study is to assess the outcomes in consecutive cirrhotic patients who had achieved portal decompression via a TIPS before major abdominal or thoracic surgery. In addition, the outcomes in the 19 cirrhotic patients with a patent TIPS undergoing major abdominal surgery were compared with historical controls without a TIPS undergoing surgery.…”