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  • Title: Preshunt and postshunt portal vein pressures and portal vein-to-inferior vena cava pressure gradients do not predict outcome following partial portal decompression.
    Author: Rosemurgy AS, Bloomston M, Ghassemi P, Serafini F.
    Journal: Am Surg; 2002 Jan; 68(1):70-4. PubMed ID: 12467322.
    Abstract:
    This study was undertaken to determine whether preshunt, postshunt, or changes in portal vein (PV) pressures or portal vein-to-inferior vena cava (PV-IVC) pressure gradients determine outcome following partial portal decompression attained through small-diameter prosthetic H-graft portacaval shunt (HGPCS). Seventy-seven adults underwent HGPCS (Child's class A 10%, B 56%, and C 34%) and were prospectively evaluated per protocol. PV pressures and PV-IVC pressure gradients decreased significantly in all patients with shunting (P < 0.001). Eight (10%) patients died within 30 days of shunting (Child's class B 50% and C 50%); seven of these deaths were due to liver failure. Preshunt, postshunt, and changes in PV pressures or PV-IVC pressure gradients with shunting were not different among eight perioperative deaths and survivors. At a mean follow-up of 3 years 24 (35%) additional patients died. Of late deaths 62 per cent were due to liver failure (Child's class B 40% and C 60%). Again preshunt, postshunt, or changes in PV pressures and PV-IVC pressure gradients with shunting did not predict who would die of late liver failure. We conclude that the small-diameter HGPCS effectively provides partial portal decompression. Preshunt or postshunt PV pressures or PV-IVC pressure gradients or changes in pressures with shunting do not determine outcome following HGPCS. Long-tern outcome is influenced by the severity of cirrhosis before shunting and by the self-destructive behaviors typical of patients with alcoholic cirrhosis.
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