title: Cardiopulmonary consequences of transjugular intrahepatic portosystemic shunts: role of increased pulmonary artery pressure.
abstract: OBJECTIVE
  To determine whether increased pulmonary artery pressure (PAP) following transjugular intrahepatic portosystemic shunting (TIPSS) results in short-term mortality or cardiorespiratory complications.
  
  
  BACKGROUND
  TIPSS is frequently performed for complications of cirrhosis. PAP increases following TIPSS; however consequences of this phenomenon are unknown.
  
  
  METHODS
  Demographics, disease severity and etiology were recorded among patients undergoing TIPSS. PAP before and following TIPSS were measured and the relationship between PAP before and after TIPSS, and subsequent cardiorespiratory complications and mortality was examined.
  
  
  RESULTS
  Thirty-one patients were enrolled (mean age 53 years, 74% men, 55% Child-Pugh class C cirrhosis). TIPSS was performed for variceal bleeding in 84% of cases. Ten patients (32%) died 5-20 days following TIPSS. PAP increased significantly following TIPSS (mean 20.8 mm Hg pre-TIPSS (95% CI 18.2-23.4) to 26.9 mm Hg post-TIPSS (95% CI 24.2-29.6, P = 0.0016). Congestive heart failure developed in 4 patients (13%), sepsis in 4 (13%), and ARDS in 8 (26%). Increased PAP following TIPSS was not associated with early mortality (P = 0.13), CHF (P = 0.31), or ARDS (P = 0.43). ARDS was the only significant predictor of short-term mortality following TIPSS (OR 18.7, P = 0.02 (95% CI: 1.5-232).
  
  
  CONCLUSIONS
  PAP increases after TIPSS and cardiorespiratory complications are common, yet unrelated to increased PAP. ARDS is independently associated with increased risk of mortality after TIPSS.
authors.affiliation: Department of Medicine, Gastroenterology Division, University of Washington, Seattle, WA, USA. schwajon@ohsu.edu
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Schwartz
authors.forename: Charles
authors.initials: C
authors.lastname: Beymer
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Althaus
authors.forename: Anne M
authors.initials: AM
authors.lastname: Larson
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.forename: David J
authors.initials: DJ
authors.lastname: Glickerman
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008103:Liver Cirrhosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects* / Q000401:mortality; D011669:Pulmonary Wedge Pressure; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D016896:Treatment Outcome