Periprocedural Cardiac Hemodynamic Changes and Clinical Outcomes After Transjugular Intrahepatic Portosystemic Shunt

To characterize serial changes in cardiac structure and function before and after transjugular intrahepatic portosystemic shunt (TIPS) using comprehensive echocardiographic assessment and to explore their clinical relevance.

This single-center retrospective cohort study included 149 patients with decompensated cirrhosis who underwent TIPS between January 2018 and October 2024. Transthoracic echocardiography was performed preoperatively, within 5 days after TIPS, and at 3-6 months of follow-up. Additional echocardiographic parameters were assessed preoperatively and early after TIPS during hospitalization to further characterize periprocedural cardiac functional changes. Echocardiographic parameters were compared across time points using repeated-measures analysis or paired tests. Kaplan-Meier survival analysis was used to examine associations with clinical outcomes.

After TIPS, right atrial diameter and right ventricular end-diastolic diameter increased significantly (both P < 0.001), accompanied by a modest increase in pulmonary artery systolic pressure (P = 0.029), while left ventricular structure and systolic function showed no significant changes. The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio showed a numerical decrease early after TIPS, followed by partial recovery during follow-up, although the changes were not statistically significant. Among the additional echocardiographic parameters, color M-mode flow propagation velocity (Vp) increased significantly from 62.8 to 75.1 cm/s (P = 0.04), whereas E/A, E/e', and other diastolic parameters remained largely unchanged. During a median follow-up of 1057 days, one patient developed early postoperative heart failure. Survival and overt hepatic encephalopathy did not differ significantly among groups stratified by baseline E/A ratio.

In patients with relatively preserved baseline cardiac function following appropriate pre-TIPS cardiovascular assessment, TIPS was associated predominantly with mild and transient right-sided cardiac changes, without significant deterioration in conventional left ventricular systolic function. The low incidence of clinically overt cardiac decompensation observed during follow-up suggests an acceptable cardiac risk profile in appropriately evaluated patients.