Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts: Role of increased pulmonary artery pressure

Jonathan M. Schwartz, Charles Beymer, Sandra J. Althaus, Anne M. Larson, Atif Zaman, David J. Glickerman, Kris V. Kowdley

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Goals: To determine whether increased pulmonary artery pressure (PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications. Background: TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown. Study: Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined. Results: Thirty-one patients were enrolled (mean age 53 years, 74% men, 55% Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84% of cases. Ten patients (32%) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95% CI 18.2-23.4) to 26.9 mm Hg post-TIPSS(95% CI 24.2-29.6, P=0.0016). Congestive heart failure developed in 4 patients (13%), sepsis in 4 (13%), and ARDS in 8 (26%). Increased PAP following TIPSS was not associated with early mortality (P=0.13), CHF (P=0.31), or ARDS (P=0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7, P=0.02 (95% CI: 1.5-232). Conclusion: PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.

Original languageEnglish (US)
Pages (from-to)590-594
Number of pages5
JournalJournal of Clinical Gastroenterology
Volume38
Issue number7
DOIs
StatePublished - Aug 2004

Fingerprint

Transjugular Intrahepatic Portasystemic Shunt
Pulmonary Artery
Pressure
Mortality
Fibrosis
Sepsis
Heart Failure
Demography
Hemorrhage

Keywords

  • Cardiorespiratory complications
  • Cirrhosis
  • Morbidity
  • Mortality
  • Portal hypertension

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts : Role of increased pulmonary artery pressure. / Schwartz, Jonathan M.; Beymer, Charles; Althaus, Sandra J.; Larson, Anne M.; Zaman, Atif; Glickerman, David J.; Kowdley, Kris V.

In: Journal of Clinical Gastroenterology, Vol. 38, No. 7, 08.2004, p. 590-594.

Research output: Contribution to journalArticle

Schwartz, Jonathan M. ; Beymer, Charles ; Althaus, Sandra J. ; Larson, Anne M. ; Zaman, Atif ; Glickerman, David J. ; Kowdley, Kris V. / Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts : Role of increased pulmonary artery pressure. In: Journal of Clinical Gastroenterology. 2004 ; Vol. 38, No. 7. pp. 590-594.
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abstract = "Goals: To determine whether increased pulmonary artery pressure (PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications. Background: TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown. Study: Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined. Results: Thirty-one patients were enrolled (mean age 53 years, 74{\%} men, 55{\%} Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84{\%} of cases. Ten patients (32{\%}) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95{\%} CI 18.2-23.4) to 26.9 mm Hg post-TIPSS(95{\%} CI 24.2-29.6, P=0.0016). Congestive heart failure developed in 4 patients (13{\%}), sepsis in 4 (13{\%}), and ARDS in 8 (26{\%}). Increased PAP following TIPSS was not associated with early mortality (P=0.13), CHF (P=0.31), or ARDS (P=0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7, P=0.02 (95{\%} CI: 1.5-232). Conclusion: PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.",
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T1 - Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts

T2 - Role of increased pulmonary artery pressure

AU - Schwartz, Jonathan M.

AU - Beymer, Charles

AU - Althaus, Sandra J.

AU - Larson, Anne M.

AU - Zaman, Atif

AU - Glickerman, David J.

AU - Kowdley, Kris V.

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N2 - Goals: To determine whether increased pulmonary artery pressure (PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications. Background: TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown. Study: Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined. Results: Thirty-one patients were enrolled (mean age 53 years, 74% men, 55% Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84% of cases. Ten patients (32%) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95% CI 18.2-23.4) to 26.9 mm Hg post-TIPSS(95% CI 24.2-29.6, P=0.0016). Congestive heart failure developed in 4 patients (13%), sepsis in 4 (13%), and ARDS in 8 (26%). Increased PAP following TIPSS was not associated with early mortality (P=0.13), CHF (P=0.31), or ARDS (P=0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7, P=0.02 (95% CI: 1.5-232). Conclusion: PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.

AB - Goals: To determine whether increased pulmonary artery pressure (PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications. Background: TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown. Study: Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined. Results: Thirty-one patients were enrolled (mean age 53 years, 74% men, 55% Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84% of cases. Ten patients (32%) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95% CI 18.2-23.4) to 26.9 mm Hg post-TIPSS(95% CI 24.2-29.6, P=0.0016). Congestive heart failure developed in 4 patients (13%), sepsis in 4 (13%), and ARDS in 8 (26%). Increased PAP following TIPSS was not associated with early mortality (P=0.13), CHF (P=0.31), or ARDS (P=0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7, P=0.02 (95% CI: 1.5-232). Conclusion: PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.

KW - Cardiorespiratory complications

KW - Cirrhosis

KW - Morbidity

KW - Mortality

KW - Portal hypertension

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