Controlled underdilation using novel VIATORR® controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation.

Autor:	Praktiknjo M; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Abu-Omar J; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Chang J; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Thomas D; Department of Radiology, University Hospital Bonn, Bonn, Germany., Jansen C; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Kupczyk P; Department of Radiology, University Hospital Bonn, Bonn, Germany., Schepis F; Division of Gastroenterology, Azienda Ospedaliero-Universitaria di Modena and University of Modena and Reggio Emilia, Modena, Italy., Garcia-Pagan JC; Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, Barcelona, Spain., Merli M; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy., Meyer C; Department of Radiology, University Hospital Bonn, Bonn, Germany., Strassburg CP; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany., Pieper CC; Department of Radiology, University Hospital Bonn, Bonn, Germany., Trebicka J; Department of Internal Medicine I, University of Frankfurt, Frankfurt, Germany.; European Foundation for the Study of Chronic Liver Failure - EF CLIF, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	JHEP reports : innovation in hepatology [JHEP Rep] 2021 Mar 03; Vol. 3 (3), pp. 100264. Date of Electronic Publication: 2021 Mar 03 (Print Publication: 2021).
DOI:	10.1016/j.jhepr.2021.100264
Abstrakt:	Background & Aims: Smaller 8-mm diameter transjugular intrahepatic portosystemic shunts (TIPS) appear to be more beneficial than larger 10-mm TIPS stent-grafts, but lack the ability for secondary dilation in cases of clinical ineffectiveness. Underdilated VIATORR® TIPS stent grafts (VTS) expand passively, whereas novel VIATORR Controlled Expansion (VCX) stent grafts do not. This study evaluated the impact on survival of underdilated VCX compared with VTS in patients with decompensated cirrhosis. Methods: This was a prospective case-control study including patients with cirrhosis receiving TIPS using 10-mm VCX underdilated to 8 mm. Patients with cirrhosis receiving 10-mm VTS underdilated to 8 mm were matched for age, sex, indication for TIPS, and liver function. Results: A total of 114 patients (47 VCX, 47 VTS, and 20 fully dilated VCX/VTS) were included. After TIPS implantation, underdilated VCX diameter was 8.0 (7.8-9.2) mm at a median time of 359 (87-450) days, compared with VTS at 9.9 (9.7-10.0) mm ( p <0.001). The portosystemic pressure gradient immediately after TIPS procedure and after 7 days did not change significantly in VCX [mean 9.4 (± 0.8) vs. 10.4 (± 0.7) mmHg, p  = 0.115). Hospital readmission rates for hepatic encephalopathy were 23% (n = 11) vs 51% (n = 24) for VCX and VTS ( p <0.001), respectively. Patients with VCX had significantly lower rates of large-volume paracentesis (n = 5 [11%] vs. n = 10 [21%], p  = 0.017) and heart failure (n = 1 [2%] vs. n = 7 [15%], p  = 0.015). One-year mortality for underdilated VCX and VTS was 15% (n = 7) and 30% (n = 14) and, for fully dilated VCX/VTS, was 45% (n = 9) (log-rank p  = 0.008), respectively. Conclusions: This study demonstrated that VCX stent grafts underdilated to 8 mm do not passively expand to nominal diameter and suggests reduced hospital readmissions because of hepatic encephalopathy, uncontrolled ascites, and heart failure, and improved 1-year survival compared with underdilated VTS. Lay Summary: Transjugular intrahepatic portosystemic shunt (TIPS) improves survival in selected patients with liver cirrhosis and acute variceal bleeding or refractory ascites. Smaller 8-mm diameter TIPS stent grafts appear to improve patient outcome compared with larger 10-mm diameter stent grafts. Novel VIATORR® Controlled Expansion (VCX) stent grafts facilitate safe and stable underdilation to 8 mm of large 10-mm diameter stent grafts with improved patient outcome (survival, hepatic encephalopathy, ascites and heart failure) compared with legacy VIATORR TIPS stent graft (VTS). Thus, the use of underdilated VCX could preserve heart function. Clinical Trials Registration: The study is registered at Clinicaltrials.govNCT03628807. Competing Interests: M.P. received funding from the 10.13039/501100008436Ernst und Berta Grimmke Foundation (Germany) (Lfd.Nr.5/19), BONFOR research program of the University of Bonn, Germany (2020-2A-07). J.T. received funding from the 10.13039/100010661European Union’s Horizon 2020 research and innovation program’s GALAXY study (No. 668031), LIVERHOPE (No. 731875), MICROB-PREDICT (No. 825694), the 10.13039/100008050Cellex Foundation, and W.L. Gore & Associates Medical. Please refer to the accompanying ICMJE disclosure forms for further details. (© 2021 The Author(s).)
Databáze:	MEDLINE
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