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

• 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
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-017-1848-1

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.