Prospective evaluation and long-term results of mesocaval interposition shunts

Mesocaval interposition shunt, using a 14 or 16 mm Dacron prosthesis, was electively performed on 86 patients (male/female ratio 52/34, aged 15-73, mean 43 years) with portal hypertension mainly due to liver cirrhosis. The selection criteria included liver volume 1,000-2,500 ml, residual portal perfusion 15-30%, no active liver disease and no stenosis of hepatic artery or celiac trunk. Intraoperative measurements showed residual portal perfusion in all studied patients. The early mortality was 8% and the follow-up mortality (1-11 years) 39%. The main causes of death were liver failure and hepatocellular carcinoma. The actuarial survival rate was c. 70% after 5, and greater than 50% after 10 years. The total encephalopathy rate was 10%. Angiography and sequential scintigraphy showed residual portal perfusion in 75% of cases soon after operation, in 60% after 6 months and 38% after 2 years. Reduction of residual portal perfusion was not associated with rising encephalopathy rate. Mesocaval interposition shunt thus was converted to total shunt during long-term follow-up. Overall shunt patency was 90%. Mesocaval interposition shunt has a place in elective or semiurgent management of portal hypertension.