Underdilation of controlled expansion transjugular intrahepatic portosystemic shunt (TIPS) preserves cardiac function and improves outcome

Background:

Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for complications of portal hypertension, but might also cause complications. Development of hepatic encephalopathy and/or cardiac dysfunction after TIPS might be among others due to the effective shunt diameter. Recently, we showed that all underdilated TIPS passively expand to nominal diameter, and that the use of the novel 10 mm Viatorr® Controlled Expansion (VTX) leads to less readmissions in patients after 3 months compared to regular Viatorr® (VTS) in the case of submaximal dilated to 8 mm. In this abstract, we report the one year outcome of VTX compared to VTS, when both groups received 10 mm stents and are submaximal dilated to 8 mm.

Methods:

46 patients receiving VTX were matched with 46 patients receiving VTS. All patients received 10 mm stents (either VTX or VTS), which were underdilated to 8 mm. Clinical, neuropsychiatric, lab work and duplex sonography data were assessed during follow up visits one year after TIPS implantation. Primary endpoints was 1-year mortality after TIPS. Secondary endpoints were development of decompensations (hepatic encephalopathy and ascites) after TIPS.

Results:

Baseline characteristics (age, MELD score, etiology of cirrhosis, indication for TIPS) were matched and not different between VTX and VTS group. Patients receiving VTX showed significantly lower rates of hepatic encephalopathy (HE) episodes and ascites during follow up. Prognostic scores (MELD, MELD-Na, CLIF-C AD und CLIF-C ACLF Score) declined significantly during follow up in VTX compared to VTS. Cardiac function (right ventricular diameter and volume and left ventricular contractility) were significantly improved in VTX patients. Consequently,1-year mortality is reduced in VTX compared to VTS.

Conclusion:

This study demonstrates reduced 1-year mortality and development of acute decompensations by using underdilated VTX compared to VTS. The lack of passive expansion of VTX stent with preserved cardiac function might represent a pathophysiological mechanism. ClinicalTrials.gov identifier: NCT03083925.