Symptomatic Heart Failure After Transjugular Intrahepatic Portosystemic Shunt Placement: Incidence, Outcomes, and Predictors

Purpose To assess the incidence of symptomatic heart failure (SHF) occurring after transjugular intrahepatic portosystemic shunt (TIPS) placement, identify potential predictors of SHF, and evaluate clinical presentation and outcomes in cases of post-TIPS SHF. Materials and Methods A prospectively ma...

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Bibliographic Details
Published in:Cardiovascular and interventional radiology 2018-04, Vol.41 (4), p.564-571
Main Authors: Modha, Kunjam, Kapoor, Baljendra, Lopez, Rocio, Sands, Mark J., Carey, William
Format: Article
Language:English
Subjects:
Bleeding
Cardiology
Clinical Investigation
Diuretics
Dyspnea
Edema
Heart diseases
Heart failure
Hypoxemia
Identification methods
Imaging
Incidence
Intubation
Medicine
Medicine & Public Health
Nuclear Medicine
Patients
Placement
Portal vein
Prothrombin
Radiology
Respiration
Septic shock
Superhigh frequencies
Tips
Ultrasound
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Summary:Purpose To assess the incidence of symptomatic heart failure (SHF) occurring after transjugular intrahepatic portosystemic shunt (TIPS) placement, identify potential predictors of SHF, and evaluate clinical presentation and outcomes in cases of post-TIPS SHF. Materials and Methods A prospectively maintained TIPS database was used to identify patients who underwent new TIPS placements at a large urban tertiary care center between 1995 and 2014. SHF was defined as otherwise unexplained new-onset dyspnea, hypoxemia, radiologic pulmonary edema, an increased need for diuretics, or need for intubation within 7 days after TIPS placement. Cases of deaths occurring within 7 days due to septic shock, continuing gastrointestinal bleed, or multi-organ failure were excluded. A control group consisting of a random sample of 40 patients from the same TIPS database was created. Uni-variable analysis was performed to assess differences between patients with and without post-TIPS SHF. Results Of the 934 TIPS procedures performed during the study period, 883 met the inclusion criteria. Eight (0.9%) patients developed SHF, usually manifested by hypoxemia (50%) or dyspnea (25%) within 48 h. Patients with SHF had higher pre-TIPS right atrial ( p  = 0.03) and portal vein ( p  = 0.01) pressures, higher albumin ( p  = 0.02), and higher prothrombin time ( p  = 0.02). Conclusion Post-TIPS SHF is rare. Higher pre-TIPS right atrial and portal vein pressures are likely to predispose patients to this complication. Close monitoring may be warranted in these patients. In our eight patients, post-TIPS SHF did not result in poor outcomes.
ISSN:0174-1551
1432-086X
DOI:10.1007/s00270-017-1848-1