Preshunt and postshunt portal vein pressures and portal vein-to-inferior vena cava pressure gradients do not predict outcome following partial portal decompression.
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.
Rosemurgy
Alexander S
AS
Department of Surgery, University of South Florida, Tampa 33601, USA.
Bloomston
Mark
M
Ghassemi
Poopak
P
Serafini
Francesco
F
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*