title: Effect of coronary-caval shunt combined with partial pericardial devascularisation on oesophageal and gastric variceal bleeding caused by portal hypertension.
abstract: OBJECTIVE
  To investigate the effect of coronary-caval shunt combined with partial pericardial devascularisation on oesophageal and gastric variceal bleeding caused by portal hypertension.
  
  
  METHODS
  Between January 2005 and January 2015, coronary-caval shunt operations combined with partial pericardial devascularisation were performed electively on 15 cirrhotic patients with portal hypertension. All of these patients had a history of oesophageal and gastric variceal bleeding. The clinical and follow-up data of these patients were reviewed retrospectively. Another 15 patients receiving non-surgical treatments in a similar follow-up period were used as controls to compare the preventive effects of different treatment strategies on rebleeding.
  
  
  RESULTS
  All of the 15 surgical procedures were performed successfully, and no severe complications occurred. Among these, autogenous splenic veins were used as bridge vessels in 6 cases, whereas the coronary vein and inferior vena cava were anastomosed directly in 9 cases. All surgical patients were followed up from 5 months to 10 years with an average of 63 months; 2 patients died due to liver failure induced by reactivation of hepatitis B virus and oesophageal/gastric variceal rebleeding, respectively. The rebleeding rates for surgical and non-surgical patients were 6.7% and 66.7% (p < 0.05), respectively, whereas the 5-year survival rates for the two groups were 85.7% and 33.3% (p < 0.05), respectively.
  
  
  CONCLUSIONS
  Patients with oesophageal and gastric variceal bleeding caused by portal hypertension may benefit from a coronary-caval shunt combined with partial pericardial devascularisation due to decreased coronary vein pressure, unaffected hepatic blood inflow, and reduced incidence of rebleeding.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. eyrechang@126.com.
authors.forename: Jigang
authors.initials: J
authors.lastname: Bai
authors.forename: Meng
authors.initials: M
authors.lastname: Xu
authors.forename: Ruitao
authors.initials: R
authors.lastname: Wang
authors.forename: Yiping
authors.initials: Y
authors.lastname: Mu
authors.forename: Shunbin
authors.initials: S
authors.lastname: Dong
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wu
authors.forename: Shengli
authors.initials: S
authors.lastname: Wu
authors.forename: Chan
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*