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Symptomatic Heart Failure After Transjugular Intrahepatic Portosystemic Shunt Placement: Incidence, Outcomes, and
Kunjam Modha1, Baljendra Kapoor2, Rocio Lopez3
1Department of Hospital Medicine, Cleveland Clinic, 9500 Euclid Avenue, M2 Annex, Cleveland, OH, 44195, USA. modhak@ccf.org.
Cardiovascular and Interventional Radiology
|November 29, 2017
Summary
Symptomatic heart failure (SHF) after transjugular intrahepatic portosystemic shunt (TIPS) is rare, occurring in 0.9% of patients. Higher pre-TIPS pressures may predict SHF, but outcomes were generally good in this study.
Area of Science:
- Cardiology
- Hepatology
- Interventional Radiology
Background:
- Transjugular intrahepatic portosystemic shunt (TIPS) procedures are common for managing complications of portal hypertension.
- Symptomatic heart failure (SHF) is a potential complication following TIPS placement.
- Understanding the incidence, predictors, and outcomes of post-TIPS SHF is crucial for patient management.
Purpose of the Study:
- To determine the incidence of symptomatic heart failure (SHF) after transjugular intrahepatic portosystemic shunt (TIPS) placement.
- To identify predictors associated with the development of post-TIPS SHF.
- To describe the clinical presentation and outcomes of patients experiencing SHF post-TIPS.
Main Methods:
- A prospectively maintained database of TIPS procedures was reviewed for patients treated between 1995 and 2014.
- Symptomatic heart failure (SHF) was defined by specific clinical and radiological criteria within 7 days of TIPS.
- Uni-variable analysis compared patients with and without post-TIPS SHF, with a control group of 40 patients.
Main Results:
- Out of 883 eligible TIPS procedures, 8 patients (0.9%) developed SHF, primarily presenting as hypoxemia or dyspnea within 48 hours.
- Patients who developed SHF had significantly higher pre-TIPS right atrial and portal vein pressures.
- Elevated pre-TIPS albumin and prothrombin time were also noted in patients with SHF.
Conclusions:
- Post-TIPS symptomatic heart failure (SHF) is an infrequent complication.
- Elevated pre-TIPS right atrial and portal vein pressures appear to be risk factors for SHF.
- Close monitoring of high-risk patients is recommended, as SHF in this cohort did not lead to adverse outcomes.
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