Abstract No. 581 Interpretation of right atrial pressure during transjugular intrahepatic portosystemic shunt creation in the setting of general anesthesia

Abstract

To evaluate how right atrial (RA) pressure is interpreted in the setting of general anesthesia during transjugular intrahepatic portosystemic shunt (TIPS) creation and whether elevated RA pressure is predictive of mortality following TIPS creation. A single-institution TIPS database was used to identify 664 patients who underwent TIPS creation under conscious sedation (CS) versus general anesthesia (GA) between 2009 and 2018. A matched cohort was created based on propensity scores using logistic regression of sedation method on demographics, liver disease status (Child-Pugh, MELD), and indications (elective, urgent, emergent). Paired analyses were performed using mixed models for RA pressure and Cox proportional hazards model with robust standard errors for mortality. Of the 664 patients, 270 patients were matched based on similar characteristics (135 for GA and 135 for CS). Indications for TIPS creation included intractable ascites (n= 170, 63%), hepatic hydrothorax (n =30, 11%), variceal bleeding (n =43, 16%), and other (n = 27, 10%). The use of GA was strongly associated with increased intra-procedural RA pressure (p<0.0001). Intra-procedural RA pressure was increased in patients undergoing TIPS creation with GA by an average of 4 mm Hg. There was no association between intra-procedural RA pressure and all-cause mortality. The type of sedation used for TIPS creation can directly affect intra-procedural RA pressure. Elevated intra-procedural RA pressure does not appear to be predictive in mortality post-TIPS creation. While careful patient selection is important, elevated RA pressures alone should not prevent patients from undergoing TIPS creation.