Cardiac volume overload and pulmonary hypertension in long‐term follow‐up of patients with a transjugular intrahepatic portosystemic shunt

Summary Background Transjugular intrahepatic portosystemic shunt (TIPSS) cause haemodynamic changes in patients with cirrhosis, yet little is known about long‐term cardiopulmonary outcomes. Aim To evaluate the long‐term cardiopulmonary outcome after TIPSS. Methods We evaluated cardiopulmonary parameters including echocardiography during long‐term follow‐up after TIPSS. Results at 1–5 years after TIPSS were compared to those of cirrhotic controls. Pulmonary hypertension (PH) diagnoses rates were included. Endothelin 1, thromboxane B2 and serotonin were measured. Results We found significant differences 1–5 years after TIPSS compared to pre‐implantation values: median left atrial diameter (LAD) increased from 37 mm [interquartile range (IQR): 33–43] to 40 mm (IQR: 37–47, P = 0.001), left ventricular end‐diastolic diameter (LV‐EDD) increased from 45 mm (range: 41–49) to 48 mm (IQR: 45–52, P < 0.001), pulmonary artery systolic pressure (PASP) increased from 25 mmHg (IQR: 22–33) to 30 mmHg (IQR: 25–36, P = 0.038). Comparing results 1–5 years post‐implantation to the comparison cohort revealed significantly higher (P < 0.05) LAD, LV‐EDD and PASP values in TIPSS patients. PH prevalence was higher in the shunt group (4.43%) compared to controls (0.91%, P = 0.150). Thromboxane B2 levels correlated with PASP in the TIPSS cohort (P = 0.033). There was no transhepatic gradient observed for the vasoactive substances analysed. Conclusions TIPSS placement is accompanied by long‐term cardiovascular changes, including cardiac volume overload, and is associated with an increased rate of pulmonary hypertension. The need for regular cardiac follow‐up after TIPSS requires further evaluation.