title: Preshunt and postshunt portal vein pressures and portal vein-to-inferior vena cava pressure gradients do not predict outcome following partial portal decompression.
abstract: This study was undertaken to determine whether preshunt, postshunt, or changes in portal vein (PV) pressures or portal vein-to-inferior vena cava (PV-IVC) pressure gradients determine outcome following partial portal decompression attained through small-diameter prosthetic H-graft portacaval shunt (HGPCS). Seventy-seven adults underwent HGPCS (Child's class A 10%, B 56%, and C 34%) and were prospectively evaluated per protocol. PV pressures and PV-IVC pressure gradients decreased significantly in all patients with shunting (P < 0.001). Eight (10%) patients died within 30 days of shunting (Child's class B 50% and C 50%); seven of these deaths were due to liver failure. Preshunt, postshunt, and changes in PV pressures or PV-IVC pressure gradients with shunting were not different among eight perioperative deaths and survivors. At a mean follow-up of 3 years 24 (35%) additional patients died. Of late deaths 62 per cent were due to liver failure (Child's class B 40% and C 60%). Again preshunt, postshunt, or changes in PV pressures and PV-IVC pressure gradients with shunting did not predict who would die of late liver failure. We conclude that the small-diameter HGPCS effectively provides partial portal decompression. Preshunt or postshunt PV pressures or PV-IVC pressure gradients or changes in pressures with shunting do not determine outcome following HGPCS. Long-tern outcome is influenced by the severity of cirrhosis before shunting and by the self-destructive behaviors typical of patients with alcoholic cirrhosis.
authors.affiliation: Department of Surgery, University of South Florida, Tampa 33601, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Poopak
authors.initials: P
authors.lastname: Ghassemi
authors.forename: Francesco
authors.initials: F
authors.lastname: Serafini
mesh_terms: D000328:Adult; D001794:Blood Pressure; D019917:Blood Vessel Prosthesis Implantation; D019299:Decompression, Surgical; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery; D011167:Portacaval Shunt, Surgical; D011169:Portal Vein / Q000503:physiopathology*; D011184:Postoperative Period; D014682:Vena Cava, Inferior / Q000503:physiopathology*