scholarly journals Transjugular Intrahepatic Portosystemic Shunt before Abdominal Surgery in Cirrhotic Patients: A Retrospective, Comparative Study

2006 ◽  
Vol 20 (6) ◽  
pp. 401-404 ◽  
Author(s):  
Evelyne Vinet ◽  
Pierre Perreault ◽  
Louis Bouchard ◽  
Denis Bernard ◽  
Ramses Wassef ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Portosystemic Shunt ◽  
Cox Proportional Hazards Model ◽  
Control Group ◽  
High Morbidity ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

Surgery in cirrhotic patients is associated with high morbidity and mortality related to portal hypertension and liver insufficiency. Therefore, preoperative portal decompression is a logical approach to facilitate abdominal surgery and hopefully to improve postoperative survival. The present study evaluated the clinical outcomes of 18 patients (mean age 58 years) with cirrhosis (seven alcoholics and 11 nonalcoholics) who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement before antrectomy (n=5), colectomy (n=10), small-bowel resection (n=1), pancreatectomy (n=1) and nephrectomy (n=1). TIPS was performed a mean (± SD) of 72±21 days before surgery and induced a marked mean decrease in portohepatic gradient from 21.4±3.9 mmHg to 8.4±3.4 mmHg. Cirrhotic patients (n=17) who underwent elective abdominal surgery without preoperative TIPS placement were used as the control group. Both groups were matched for age, etiology of cirrhosis, indications for surgery, type of surgery and coagulation parameters. The mean Pugh score was significantly higher in the TIPS group (7.7 versus 6.2). No significant differences were observed for operative blood loss, postoperative complications, duration of hospitalization and one-month (83% versus 88%) or one-year (54% versus 63%) cumulative survival rate. Analysis using the Cox proportional hazards model showed that neither TIPS placement nor preoperative Pugh score were independent predictors for survival. The present study suggests that preoperative TIPS placement does not improve postoperative evolution after abdominal surgery in cirrhotic patients with good or moderately impaired liver function.

scholarly journals Systemic and Splanchnic Lipopolysaccharide and Endothelin-1 Plasma Levels in Liver Cirrhosis before and after Transjugular Intrahepatic Portosystemic Shunt

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jiaxiang Meng ◽  
Qing Wang ◽  
Kai Liu ◽  
Shuofei Yang ◽  
Xinxin Fan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Bacterial Translocation ◽  
Portosystemic Shunt ◽  
Before And After ◽  
Intrahepatic Portosystemic Shunt ◽  
Cirrhotic Patients

Lipopolysaccharide (LPS) and endothelin- (ET-) 1 may aggravate portal hypertension by increasing intrahepatic resistance and splanchnic blood flow. In the portal vein, after TIPS shunting, LPS and ET-1 were significantly decreased. Our study suggests that TIPS can benefit cirrhotic patients not only in high hemodynamics related variceal bleeding but also in intestinal bacterial translocation associated complications such as endotoxemia.

Abstract 282: Impact of a Multi-Disciplinary Heart Failure Post-Discharge Management Clinic on Heart Failure Readmission Rates

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Cynthia Jackevicius ◽  
Noelle de Leon ◽  
Lingyun Lu ◽  
Donald Chang ◽  
Alberta Warner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Control Group ◽  
Post Discharge ◽  
Readmission Rates ◽  
All Cause Mortality ◽  
Clinic Group

Background: Specialized heart failure (HF) clinics have demonstrated significant reduction in readmission rates. We evaluated a new multi-disciplinary HF clinic focused specifically on those recently discharged from a HF hospitalization. Methods: In this retrospective, cohort study, patients discharged with a primary HF diagnosis who attended the HF post-discharge clinic in 2010-11 were compared with historical controls from 2009. Within an average of six clinic visits, patients were seen by a physician assistant, a clinical pharmacist and a nurse case manager, with care overseen by an attending cardiologist. The clinic focused on identification of HF etiology and precipitating factors, medication titration to target doses, patient education, and medication adherence. The primary outcome was 90-day HF readmission, with secondary outcomes of mortality and a composite of 90-day HF readmission and mortality. A Cox proportional hazards model with adjustment for potentially confounding demographic and comorbidity variables was constructed to compare outcomes between groups. Results: Among the 277 patients (144 clinic and 133 control) in the study, 7.6% of patients in the clinic group and 23.3% of patients in the control group were readmitted for HF within 90 days (aHR 0.26; 95%CI=0.13-0.53 p = 0.0003;aRRR=74%; 95%CI= 47%-87%; ARR=15.7%;NNT=7). There were few deaths, but adjusted all-cause mortality was lower in the clinic group. For the composite of 90-day HF readmission and mortality, clinic patients had a lower risk (9.0% vs 28.6%; aHR 0.23; 95%CI=0.12-0.45; p<0.0001; aRRR=77%; 95%CI=55%-88%;ARR=19.6%;NNT=6). Conclusion: The multidisciplinary HF post-discharge clinic was associated with a significant reduction in 90-day HF readmission rates and all-cause mortality.

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