3:27 PM Abstract No. 250 Computed tomography changes after transjugular intrahepatic portosystemic shunt placement: can we predict who will need a revision?

TIPS has been shown to increase cardiac output and pulmonary artery systolic pressure. Patients who suffered symptomatic heart failure after TIPS placement had higher pre-TIPS right atrial and portal pressures. This study was performed to assess if RV/LV ratio, a validated tool to asses right heart strain, predicts outcomes after TIPS placement. This single-institution, IRB-approved retrospective study identified 86 adult patients (mean age, 54.3 ± 10.5; 65.1% male) from 2008 to 2018 who underwent a TIPS procedure and had a pre-TIPS contrast-enhanced CT (CECT) within 3 months and a post-TIPS CECT within 1 year. Average MELD score was 14.4 ± 4.6 (range, 6-25). The etiology of cirrhosis included alcohol (45%), hepatitis C (34%), nonalcoholic steatohepatitis (24%), hepatitis B (2%), and other (9%). CT findings, procedural information, and post procedure clinical course were reviewed. CT scans were reviewed for RV/LV ratio. Primary endpoint was necessary for TIPS reduction or composite endpoint (TIPS reduction, development of pulmonary edema, or post procedure intubation). TIPS stent diameters placed included 8 mm (3.6%), 10 mm (89.1%), and 12 mm (7.2%). The mean pre- and post-TIPS HVPG was 17.8 ± 5.8 mm Hg and 6.5 ± 3.3 mm Hg respectively. There was no correlation between mean pre- and post-TIPS RV/LV ratio (0.9 ± 0.2 vs. 0.9 ± 0.2, P = 0.9). The first post-TIPS CT was performed at a mean of 95.7 ± 95 days, and there was no association between time of post-TIPS CT and RV/LV ratio (P = 0.5). After TIPS, 5 (6%) patients developed pulmonary edema, 7 (8%) required intubation (all cause), and 17 (20%) had a TIPS reduction (mean time to TIPS reduction, 179.4 ± 286.7 days). MELD score, Child-Pugh class, TIPS dilation, pre/post/change in HVPG, and pre/post change in RV/LV ratio were not predictive of TIPS reduction or composite endpoint. Although RV/LV ratio is useful to detect hemodynamic changes of right heart strain from pulmonary embolism; it is not a reliable metric to detect hemodynamic changes from TIPS placement, predict postprocedural pulmonary complication, or predict the need for TIPS revision.