Abstract No. 647 Outcomes of transjugular intrahepatic portosystemic shunt creation in patients with elevated intraprocedural right heart pressures

Right heart failure with elevated central venous pressure is a relative contraindication for TIPS procedure. Increased right atrial pressure has been described as a significant prognostic factor for poor outcomes and early mortality following TIPS creation. However, literature on outcomes in patients who undergo TIPS creation with elevated intraprocedural right heart pressures is limited. This is an IRB-approved, single-arm, retrospective review of 65 patients (32:33 M:F, age range 23-73 years) who underwent TIPS creation at a tertiary referral center from 2009 to 2018 with elevated intraprocedure right atrial pressures greater than or equal to 20mm Hg. Demographic, procedural and outcomes data pertaining to heart failure exacerbation requiring hospitalization and all-cause mortality within 30 days, 6 months and beyond 6 months were collected and summarized. Of the 65 patients who underwent TIPS with intraprocedural RA pressure greater than or equal to 20mm Hg, 6 patients were lost to follow-up. Of the 59 patients with follow-up data, none were re-admitted within the hospital system for heart failure exacerbation. Four patients died within 30 days (3 from respiratory failure, 1 from septic shock). Five patients died within 6 months (3 from respiratory failure, 2 from septic shock). Seven patients died beyond 6 months (2 from hemorrhagic stroke, 3 from respiratory failure and 2 from septic shock). Despite concern that TIPS in patients with elevated intraprocedure right atrial pressures may lead to acute exacerbation of right heart failure, none of the 59 patients with follow-up data were found to have hospital re-admission within 6 months of TIPS creation for heart failure exacerbation. Respiratory failure and septic shock were the most common cause of death at 30 days and 6 months following TIPS. Further analysis with propensity matching for patients with RA pressures less than 20mm Hg is pending.