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Kamel YA, Elmoniar MM, Fathi YI, Lotfi ME, Alwarraky MS, Yassen KA. Monitoring haemodynamic changes during transjugular portosystemic shunt insertion with electric cardiometry in sedated and spontaneous breathing patients. A diagnostic test accuracy study. J Anaesthesiol Clin Pharmacol 2023; 39:127-133. [PMID: 37250237 PMCID: PMC10220200 DOI: 10.4103/joacp.joacp_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/04/2021] [Accepted: 06/25/2021] [Indexed: 03/21/2023] Open
Abstract
Background and Aims Transjugular intrahepatic portosystemic shunt (TIPS) allows a high blood volume into systemic circulation abruptly. The primary aim of the study was to investigate the effect of TIPS on systemic, portal hemodynamics, and electric cardiometry (EC) parameters in sedated and spontaneous breathing patients. Secondary aims?? Material and Methods Adult consecutive hepatic patients scheduled for elective TIPS were included. Patients were sedated with bispectral index-guided propofol infusion + fentanyl boluses. EC parameters, i.e., cardiac output (CO) and systemic vascular resistance (SVR) were noted. Noninvasive blood pressure, heart rate, central venous pressure (CVP, cmH2O), and portal venous pressure (PVP, cmH2O) were measured pre- and post-TIPS. Results Thirty-six people were enrolled (n = 25 included) from Aug 2018 to Dec 2019. Data (expressed in median (IQ)) were: age 33 (27-40) years, body mass index 24 (22.0-27) kg/m2, child A 60%, B 36%, and C 4%. Post-TIPS, PVP decreased (from 40 [37-45] to 34 [27-37] mmHg, P < 0.001), whereas CVP increased (from 7 [4-10] to 16 [10.0-19.0] mmHg, P < 0.001). The CO increased (P = 0.03) and SVR reduced (P = 0.012). Conclusion The reduction in PVP following successful TIPS insertion elevated the CVP abruptly. EC was able to monitor an immediate increase in the CO and a reduction in SVR in association with the above PVP and CVP changes. The results of this unique study indicate that EC monitoring is promising; however, further evaluation in a larger population and in correlation with other gold-standard CO monitors is still indicated.
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Affiliation(s)
- Yasmin A. Kamel
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Mahmoud M. Elmoniar
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Yasser I. Fathi
- Department of Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt
| | - Mamdouh E. Lotfi
- Department of Anaesthesia Department, Faculty of Medicine, Menoufia University, Sheeben Elkom City, Egypt
| | - Mohamed S. Alwarraky
- Department of Radiology, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
| | - Khaled A. Yassen
- Department of Anaesthesia, National Liver Institute, Menoufia University, Sheeben Elkom City, Egypt
- Department of Anaesthesia Unit, Surgery Department, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia
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Banini BA, Alwatari Y, Stovall M, Ogden N, Gershman E, Shah RD, Strife BJ, Shojaee S, Sterling RK. Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence-Based Review and Guidance. Hepatology 2020; 72:1851-1863. [PMID: 32585037 DOI: 10.1002/hep.31434] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/08/2020] [Accepted: 06/04/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Bubu A Banini
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Yahya Alwatari
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Madeline Stovall
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Nathan Ogden
- Division of Interventional Radiology, Department of Radiology, Virginia Commonwealth University, Richmond, VA
| | - Evgeni Gershman
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Rachit D Shah
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, VA
| | - Brian J Strife
- Division of Interventional Radiology, Department of Radiology, Virginia Commonwealth University, Richmond, VA
| | - Samira Shojaee
- Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA
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Ascha M, Hanouneh M, S Ascha M, Zein NN, Sands M, Lopez R, Hanouneh IA. Transjugular Intrahepatic Porto-Systemic Shunt in Patients with Liver Cirrhosis and Model for End-Stage Liver Disease ≥15. Dig Dis Sci 2017; 62:534-542. [PMID: 27154510 DOI: 10.1007/s10620-016-4185-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 04/26/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND It is not known whether transjugular intrahepatic porto-systemic shunt (TIPS) is safe in patients with advanced liver cirrhosis. The aim of our study was to evaluate the impact of TIPS on transplant-free survival in patients with liver cirrhosis and MELD score ≥15. METHODS All adult patients who underwent TIPS at our institution between 2004 and 2011 were identified (N = 470). A total of 144 patients had MELD ≥15 at the time of TIPS. These patients were matched 1:1 to patients with liver cirrhosis who did not undergo TIPS based on age and MELD score using the greedy algorithm. Patients were followed up until time of death or liver transplantation. Kaplan-Meier curves and log-rank tests were used to test for differences in survival outcome between the two groups. RESULTS A total of 288 patients with liver cirrhosis were included, of whom 144 underwent TIPS and 144 did not. The two groups were matched based on age and MELD score and were comparable with regard to gender and ethnicity. Mean MELD and Child-Pugh scores in the study population were 20.9 ± 6.5 and 10.5 ± 1.8, respectively. The most common indication for TIPS was varices (49 %), followed by refractory ascites (42 %). In the first 2 months post-TIPS, there was increased mortality or liver transplantation in patients who had TIPS compared to those who did not, but this did not reach statistical significance (p = 0.07). However, after 2 months, TIPS is associated with 56 % lower risk of dying or needing liver transplantation (p < 0.01) than cirrhotic patients who did not undergo TIPS. CONCLUSION In patients with liver cirrhosis and MELD ≥15, TIPS might improve transplant-free survival for patients who live for at least 2 months after the procedure.
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Affiliation(s)
- Mona Ascha
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamad Hanouneh
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mustafa S Ascha
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Nizar N Zein
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Sands
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Quantitative Health Science, Cleveland Clinic, Cleveland, OH, USA
| | - Ibrahim A Hanouneh
- Minnesota Gastroenterology, P.A., P.O. Box 14909, Minneapolis, MN, 55414, USA.
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Hayek G, Ronot M, Plessier A, Sibert A, Abdel-Rehim M, Zappa M, Rautou PE, Valla D, Vilgrain V. Long-term Outcome and Analysis of Dysfunction of Transjugular Intrahepatic Portosystemic Shunt Placement in Chronic Primary Budd-Chiari Syndrome. Radiology 2016; 283:280-292. [PMID: 27797679 DOI: 10.1148/radiol.2016152641] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate the long-term safety, technical success, and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in a series of patients with Budd-Chiari syndrome (BCS), and to determine the predictors of shunt dysfunction. Materials and Methods From 2004 to 2013, all patients with primary BCS referred for TIPS placement were included in the study. The primary and secondary technical success rates and the number and types of early (ie, before day 7) complications were noted. Factors associated with dysfunction were analyzed with uni- and multivariate analyses. Survival was analyzed with Kaplan-Meier curves. Results Fifty-four patients (34 women [63%]; mean age, 36 years ± 12 [standard deviation]) were included. Twenty-eight patients (52%) had myeloproliferative neoplasms. The mean Model for End-Stage Liver Disease score was 14.5 ± 4. The most frequent indication for TIPS was refractory ascites (50 of 54; 93%). Primary and secondary technical success rates were 93% and 98%, respectively. Early complications occurred in 17 patients (32%). After a mean follow-up of 56 months ± 41 (interquartile range, 22-92), 22 patients (42%) experienced at least one episode of TIPS dysfunction (median delay between administration of TIPS and first episode of dysfunction, 10.8 months). Cumulative 1-, 2-, 3-, 5-, and 10-year primary patency rates were 64%, 59%, 54%, 45%, and 45%, respectively. Dysfunction was associated with a myeloproliferative neoplasm (hazard ratio, 8.18; 95% confidence interval: 1.45, 46.18; P = .017), more than two initial stents (hazard ratio, 3.90; 95% confidence interval:1.16, 13.10; P = .027), and the occurrence of early complications (hazard ratio, 11.34; 95% confidence interval: 1.82, 70.69; P = .009). The 10-year survival rate was 76%. Conclusion TIPS placement in patients with chronic primary BCS was associated with a nonnegligible rate of early complications and required endovascular revision or revisions in 42% of patients. Nevertheless, secondary patency was close to 100%, and long-term survival was good. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Georges Hayek
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Maxime Ronot
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Aurélie Plessier
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Annie Sibert
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Mohamed Abdel-Rehim
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Magaly Zappa
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Pierre-Emmanuel Rautou
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Dominique Valla
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
| | - Valérie Vilgrain
- From the Departments of Radiology (G.H., M.R., A.S., M.A.R., M.Z., V.V.) and Hepatology (A.P., P.E.R., D.V.), APHP, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France (M.R., P.E.R., D.V., V.V.); and INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France (M.R., V.V.)
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