Prognostic Value of Baseline Pre-procedure Right Atrial Pressure for Clinical Outcomes after Transjugular Intrahepatic Portosystemic Shunt Creation: Results from the EuroTIPS Registry

Sunday, March 30, 2025

3:00 PM – 3:09 PM CT

Location: Music City Center, 202 A

Presenting Author(s)

RG

Ron C. Gaba, MD, MS

Professor
University of Illinois at Chicago, United States

Author/Co-author(s)

AB

Anna Baiges, MD, PhD

Attending physician
Universitat de Barcelona, Spain
FS

Filippo Schepis, MD

Professor
Università degli Studi di Modena e Reggio Emilia, Italy
TG

Tomas Guasconi, MD

Professor
Università degli Studi di Modena e Reggio Emilia, Italy
DS

Dario Saltini, MD

Professor
Università degli Studi di Modena e Reggio Emilia, Italy
JT

Jonel Trebicka, MD, PhD

Professor
University Clinic Münster, Germany
MK

Markus Kimmann, MD

Professor
University Clinic Münster, Germany
MP

Michael Praktiknjo, MD

Professor
University Clinic Münster, Germany
CB

Christophe Bureau, MD, PhD

Professor
University of Toulouse, France
HL

Helene Larrue, MD

Professor
University of Toulouse, France
AA

Agustin Albillos, MD

Professor
Hospital Universitario Ramón y Cajal, Spain
LT

Luis Tellez, MD

Professor
Hospital Universitario Ramón y Cajal, Spain
DT

Dominique Thabut, MD

Professor
Sorbonne-Université, France
MR

Marika Rudler, MD

Professor
Sorbonne-Université, France
CB

Charlotte Bouzbib, MD

Professor
Sorbonne-Université, France
WL

Wim Laleman, MD

Professor
Universitair Ziekenhuis Leuven, Belgium
EV

Emma Vanderschueren, MD

Professor
Universitair Ziekenhuis Leuven, Belgium
DT

Dhiraj Tripathi, MD

Professor
University of Birmingham, United Kingdom
FK

Faisal Khan, MD

Professor
University of Birmingham, United Kingdom
AZ

Ali Zafa, MD

Professor
University of Birmingham, United Kingdom
TR

Thomas Reiberger, MD

Professor
Medical University of Vienna, Austria
LH

Lukas Hartl, MD

Professor
Medical University of Vienna, Austria
MS

Marco Senzolo, MD

Professor
University of Padova, Italy
AG

Alvaro Giraldez-Gallego, MD

Professor
Hospital Universitario Virgen del Rocío, Spain
FV

Francesco Vizzutti, MD

Professor
University of Florence, Italy
PB

Pablo Bellot Garcia, MD

Professor
Hospital General Universitario de Alicante, Spain
LE

Laure Elkrief, MD

Professor
Tours University Hospitals, France
Ld

Louis d'Alteroche, MD

Professor
Tours University Hospitals, France
FT

Fanny Turon, MD, PhD

Professor
Universitat de Barcelona, Spain
VH

Virginia Hernandez-Gea, MD, PhD

Professor
Universitat de Barcelona, Spain
JG

Juan-Carlos Garcia-Pagan, MD, PhD

Attending physician
Universitat de Barcelona, Spain

Purpose: The hemodynamic consequences of transjugular intrahepatic portosystemic shunt (TIPS) creation include increased cardiac preload resulting in increased cardiac output and potentially in elevated pulmonary arterial pressures. Limited cardiac reserve may result in cardiac decompensation and mortality. Prior published data from the United States have suggested that baseline right atrial pressure (RAP) may have predictive value for post-TIPS mortality, and accordingly, an elevated pre-TIPS RAP constitutes a relative contraindication to shunt creation. However, independent validation in other cohorts is lacking. This study thus investigated the impact of RAP on mortality in a European cohort of patients undergoing TIPS creation.

Materials and Methods: A dataset from the prospective EuroTIPS registry generated by 17 European centers were analyzed. This study included 651 patients (men: 479, 74%; median age: 58 years; alcohol cirrhosis: 431, 66%) who underwent TIPS between 2015-2023 and had available RAP and clinical outcome data. The influence of demographic (age, sex), liver disease (Model for End-stage liver disease [MELD]), treatment (use of beta-blockers, vasoactive drugs), and procedure (indication, pre-TIPS RAP, pre- and post-TIPS portosystemic pressure gradient [PPG], stent diameter/dilation) data on 1-year Kaplan-Meier time-to-event transplant-free survival (TFS) was assessed using Cox proportional hazards regression.

Results: TIPS were created for portal hypertensive bleeding (n=288, 44%), ascites (n=234, 36%), or other indications (n=129, 20%). Median PPG decreased from 17 to 9 mm Hg. Median pre-TIPS RAP was 8 (range 1-34) mm Hg. Median MELD was 12 (range 6-38). 30-day, 6-month, and 1-year survival rates were 94%, 84%, and 76%. Only age, MELD, and RAP were significantly associated with 1-year TFS on both univariable (age: HR 1.029, 95% CI 1.012-1.046, P< 0.001; MELD: HR 1.075, 95% CI 1.048-1.102, P< 0.001; RAP: HR 0.960, 95% CI 0.927-0.995, P=0.027) and multivariable (age: HR 1.035, 95% CI 1.017-1.054, P< 0.001; MELD: HR 1.068, 95% CI 1.012-1.127, P< 0.001; RAP: HR 0.947, 95% CI 0.911-0.984, P=0.005) analysis. Among non-transplanted patients, mortality for patients with pre-TIPS RAP ≤10 vs. ≥11 mm Hg was 25% (101/397) vs. 19% (36/195) (P=0.062).

Conclusion: Pre-TIPS RAP showed independent prognostic value for 1-year post-TIPS TFS, with a protective effect, which contrasts with other published data. It is possible that higher RAP may promote early cardiac adaptation and prevent cardiac morbidity.