Advanced Hemodynamic Monitoring before and after Transjugular Intrahepatic Portosystemic Shunt: Implications for Selection of Patients—A Prospective Study

Saugel, Bernd; Phillip, Veit; Gaa, Jochen; Berger, Hermann; Lersch, C.; Schultheiß, Caroline; Thies, Philipp; Schneider, Heike; Höllthaler, Josef; Herrmann, A; Schmid, Roland M.; Huber, Wolfgang

doi:10.1148/radiol.11110043

Cited by 27 publications

(25 citation statements)

References 30 publications

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“…We recorded 3 TDCO values in each patient. TDCO measurements were performed as described previously using a PiCCO-Plus or PiCCO-2 monitor (Pulsion Medical Systems SE) [11,12]. For a thermodilution measurement, we injected 15 mL of iced 0.9 % saline via a central The algorithm used for the determination of CNCO is based on the pulse contour analysis of the arterial waveform noninvasively recorded with CNAP.…”

Section: Cardiac Output Determination By Transpulmonary Thermodilutionmentioning

confidence: 99%

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Wagner

Grond²,

Fortin³

et al. 2015

J Clin Monit Comput

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The CNAP system (CNSystems Medizintechnik AG, Graz, Austria) provides noninvasive continuous arterial pressure measurements by using the volume clamp method. Recently, an algorithm for the determination of cardiac output by pulse contour analysis of the arterial waveform recorded with the CNAP system became available. We evaluated the agreement of the continuous noninvasive cardiac output (CNCO) measurements by CNAP in comparison with cardiac output measurements invasively obtained using transpulmonary thermodilution (TDCO). In this proof-of-concept analysis we studied 38 intensive care unit patients from a previously set up database containing CNAP-derived arterial pressure data and TDCO values obtained with the PiCCO system (Pulsion Medical Systems SE, Feldkirchen, Germany). We applied the new CNCO algorithm retrospectively to the arterial pressure waveforms recorded with CNAP and compared CNCO with the corresponding TDCO values (criterion standard). Analyses were performed separately for (1) CNCO calibrated to the first TDCO (CNCO-cal) and (2) CNCO autocalibrated to biometric patient data (CNCO-auto). We did not perform an analysis of trending capabilities because the patients were hemodynamically stable. The median age and APACHE II score of the 22 male and 16 female patients was 63 years and 18 points, respectively. 18 % were mechanically ventilated and in 29 % vasopressors were administered. Mean ± standard deviation for CNCO-cal, CNCO-auto, and TDCO was 8.1 ± 2.7, 6.4 ± 1.9, and 7.8 ± 2.4 L/min, respectively. For CNCO-cal versus TDCO, Bland-Altman analysis demonstrated a mean difference of +0.2 L/min (standard deviation 1.0 L/min; 95 % limits of agreement -1.7 to +2.2 L/min, percentage error 25 %). For CNCO-auto versus TDCO, the mean difference was -1.4 L/min (standard deviation 1.8 L/min; 95 % limits of agreement -4.9 to +2.1 L/min, percentage error 45 %). This pilot analysis shows that CNCO determination is feasible in critically ill patients. A percentage error of 25 % indicates acceptable agreement between CNCO-cal and TDCO. The mean difference, the standard deviation, and the percentage error between CNCO-auto and TDCO were higher than between CNCO-cal and TDCO. A hyperdynamic cardiocirculatory state in a substantial number of patients and the hemodynamic stability making trending analysis impossible are main limitations of our study.

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Section: Cardiac Output Determination By Transpulmonary Thermodilutionmentioning

confidence: 99%

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Wagner

Grond²,

Fortin³

et al. 2015

J Clin Monit Comput

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“…Our study also showed increased levels of HGB in both groups, with patients receiving combined therapy of TIPS and PSE having higher HGB levels, which may be related to reduced blood loss obtained by TIPS and reduced intrasplenic destruction of RBC obtained by PSE. Bernd Saugel et al [22] reported that the TIPS procedure led to a significant increase in serum bilirubin level, ALT and AST levels, and INR level as well. Earlier studies [23,24] reported that TIPS can result in a deterioration of the liver function in the form of elevation of bilirubin, ALT and AST, probably due to reduction of hepatic blood flow and sinusoidal blood flow resulting from diversion of portal blood through a TIPS, which is even more obvious in patients with advanced liver disease due to incomplete hepatic artery buffer response [25] .…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

Wan

Yang

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM:To evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) in combination with partial splenic arterial embolization (PSE) for cirrhotic patients with recurrent variceal bleeding and hypersplenism. METHODS: Institutional review board approval was obtained; all patients provided informed consent. From January 2010 to December 2014, a total of 141 cirrhotic patients received TIPS alone(group A, n=114) and simultaneous combined TIPS and PSE(group B, n=27) for recurrent variceal bleeding and hypersplenism secondary to portal hypertension. The TIPS was created by using covered stents. All patients underwent embolotherapy via the jugular vein after TIPS implantation. Patients in group B (n=27) received simultaneous PSE after creation of TIPS. Biochemical tests, coagulation function, complete blood cell (CBC) counts, frequencies of recurrent variceal bleeding and hepatic encephalopathy (HE), and survival were evaluated. Model for end stage liver diseases (MELD) scores were calculated. RESULTS: TIPS creation was successful in all patients. After the treatments, patients in group B had better hepatic synthetic function, increased levels of white blood cells (WBC), platelets (PLT), and hemoglobin(HGB), lower frequency of HE, lower overall and cirrhosis-related mortality than patients in group A (P<0.05), though the two groups had similar recurrent variceal bleeding frequency (P>0.05). Multivariate analysis showed that MELD scores, HE, and group were independent factors for overall and liver-related mortality at month 24 (P<0.05). No severe complications were observed in the two groups. CONCLUSIONS: Simultaneous combined TIPS and PSE regimen improves hematologic parameters, prevents deterioration of liver function and coagulation function, reduces variceal bleeding and HE, thus reduces mortality.

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“…However, concerns have repeatedly been raised that this TIPS-induced increase in cardiac preload might promote circulatory failure in cirrhotic patients [5][6][7]. Just contrary, we hypothesizedbased on the results of a previous prospective exploratory study of our group [8]-that TIPS improves cardiocirculatory function in terms of increased blood flow in cirrhotic patients.…”

Section: Introductionmentioning

confidence: 93%

“…After insertion of a 10-French introducer sheath in the internal jugular vein, the TIPS procedure was performed as described before with a commercially available set (TIPSS-100; William Cook Europe, Bjaeverskov, Denmark) [8,9]. As previously described [8], after the creation of an intraparenchymal track from the right hepatic vein to the right portal vein (or a branch of the right portal vein), an uncovered self-expandable stent (Wallstent-Uni Endoprothesis; Boston Scientific Corporation, Natick, Mass) was placed after balloon dilation (Fox Plus; Abbott Vascular, Beringen, Switzerland).…”

Section: Transjugular Intrahepatic Portosystemic Stent Shunt and Detementioning

confidence: 99%

“…As previously described [8], after the creation of an intraparenchymal track from the right hepatic vein to the right portal vein (or a branch of the right portal vein), an uncovered self-expandable stent (Wallstent-Uni Endoprothesis; Boston Scientific Corporation, Natick, Mass) was placed after balloon dilation (Fox Plus; Abbott Vascular, Beringen, Switzerland). Before and after the TIPS procedure, the portosystemic pressure gradient (portal pressure -central venous pressure (CVP)) was assessed.…”

Section: Transjugular Intrahepatic Portosystemic Stent Shunt and Detementioning

confidence: 99%

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The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters

Saugel

Mair

Meidert

et al. 2014

Journal of Critical Care

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Advanced Hemodynamic Monitoring before and after Transjugular Intrahepatic Portosystemic Shunt: Implications for Selection of Patients—A Prospective Study

Abstract: Patients with renal insufficiency, compensated hepatocellular function, decreased cardiac preload, and decreased cardiac performance benefit most from TIPS.

Cited by 27 publications

References 30 publications

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Continuous noninvasive cardiac output determination using the CNAP system: evaluation of a cardiac output algorithm for the analysis of volume clamp method-derived pulse contour

Simultaneous Combined Transjugular Intrahepatic Portosystemic Shunt and Partial Splenic Embolization for Decompensated Cirrhosis

The effects of transjugular intrahepatic portosystemic stent shunt on systemic cardiocirculatory parameters

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