title: The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters.
abstract: OBJECTIVE
  We aimed to evaluate the effects of transjugular intrahepatic portosystemic stent shunt (TIPS) on systemic cardiocirculatory parameters in patients treated with TIPS for portal hypertension-associated complications.
  
  
  METHODS
  This prospective study was conducted in an intensive care unit of a German university hospital (October 2010-July 2013). We assessed hemodynamic parameters before and after TIPS placement using single-indicator transpulmonary thermodilution and pulse contour analysis. After exclusion of 5 patients treated with vasoactive agents during study measurements, 15 patients were included in the final statistical analysis.
  
  
  RESULTS
  Transjugular intrahepatic portosystemic stent shunt induced a statistically significant decrease in portal pressure (median, 29 [25%-75% percentile range, 23-37] mm Hg before TIPS vs 21 [18-27] mm Hg after TIPS; P<.01) in parallel with a statistically significant increase in central venous pressure (10 [6-15] mm Hg before TIPS vs 13 [9-16] mm Hg after TIPS; P=.01), cardiac index (3.8 [2.9-4.6] L min(-1) m(-2) before TIPS vs 4.5 [3.8-5.4] L min(-1) m(-2) 14 hours after TIPS; P=.01), and stroke volume index (54 [42-60] mL/m2 before TIPS vs 60 [47-63] mL/m2 14 hours after TIPS; P=.03). Arterial blood pressure and systemic vascular resistance index were statistically significantly lower after TIPS.
  
  
  CONCLUSIONS
  Transjugular intrahepatic portosystemic stent shunt placement is associated with an increase in central venous pressure and an improvement of global blood flow (cardiac index and stroke volume index) in patients with portal hypertension.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany. Electronic address: bernd.saugel@gmx.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Saugel
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mair
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Agnes S
authors.initials: AS
authors.lastname: Meidert
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Phillip
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Marlena
authors.initials: M
authors.lastname: Messer
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Nennstiel
authors.affiliation: Abteilung für Interventionelle Radiologie, Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Berger
authors.affiliation: Abteilung für Interventionelle Radiologie, Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gaa
authors.affiliation: III. Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Julia Y
authors.initials: JY
authors.lastname: Wagner
authors.affiliation: Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Schneider
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
mesh_terms: D000368:Aged; D001775:Blood Circulation / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D002496:Central Venous Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011170:Portasystemic Shunt, Surgical; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies; D011674:Pulse; D015607:Stents; D013318:Stroke Volume / Q000502:physiology*; D013815:Thermodilution / Q000379:methods*
keywords: Cardiac index; Hemodynamic monitoring; Liver cirrhosis; Portal hypertension; Transpulmonary thermodilution