Small diameter H-graft porta-caval shunt performed at different stages of liver disease
Giacomo Batignani, Francesco Vizzutti, Luigi Rega, Michele Zuckermann, Geri Fratini, Massimo Pinzani and Francesco Tonelli
Firenze, Italy
Author Affiliations: Dipartimento di Fisiopatologia Clinica-Unità di Chirurgia (Batignani G, Zuckermann M, Fratini G and Tonelli F); Dipartimento di Medicina Interna Sezione Clinica Medica ed Epatologia Laboratorio di Emodinamica Epatica (Vizzutti F and Pinzani M); and Dipartimento di Fisiopatologia Clinica Unità di Radiodiagnostica (Rega L), Università degli Studi di Firenze, Viale Morgagni, 85-50134-Firente, Italy Corresponding Author: Giacomo Batignani, MD, Dipartimento di Fisiopatologia Clinica-Unità di Chirurgia, Viale Morgagni, Università degli Studi di Firenze, 85-50134-Firenze, Italy (Tel: 39-055428900; Fax: 39-0554361770; Email: giacomo.batignani@unifi.it)
BACKGROUND: Partial porto-systemic shunts have been popularized because of reported low rate of mortality and morbidity (especially encephalopathy, liver failure and occlusion). To further investigate these assumptions, we retrospectively reviewed the results of partial porta-caval shunts performed at different stages of liver disease.
METHODS: Twenty-nine cirrhotic patients underwent a partial porta-caval shunt with a ringed polytetrafluoroethylene interposition prosthesis of 8-mm (20 patients) or 10-mm (9 patients) in diameter. Pre- and post-shunt porta-caval pressure was measured in all patients. Twelve patients (41.4%) belonged to Child A, 11 Child B (37.9%), and 6 Child C (20.7%). Eleven patients (37.9%) suffered from hepatic encephalopathy preoperatively. Twelve patients (41%) were operated on in emergency/urgency.
RESULTS: Porta-caval pressure gradient, reduced significantly using either 8- or 10-mm prosthesis. The overall early mortality and morbidity were 13.8% and 48% respectively. The early mortality and morbidity were different between patients of Child A and B when compared to those of Child C (0 vs 66.6% and 34.8% vs 66.6% respectively). No patient re-bled early from varices. The overall late mortality and morbidity were 40% and 64% respectively. Shunt thrombosis and stenosis took place in 16% and 8% of the two groups of patients respectively; variceal re-bleeding occurred in 4 patients (16%). Encephalopathy occurred postoperatively in 5 patients (20%), acute in 3 patients (12%), and chronic in 2 (8%). The actuarial survival rate at 3 and 5 years was 92% and 75% for patients of Child A, 70% and 60% for patients of Child B, and 0% for patients of Child C.
CONCLUSIONS: Our results indicate that partial porta-caval shunt with a small diameter interposition H-graft is an effective procedure for the treatment of variceal bleeding, as well as for the prevention of re-bleeding in patients of Child A and those of Child B, as an elective or emergency/urgency procedure, with a low rate of complications and encephalopathy. This technique could be used safely in patients with good liver function but they should be monitored closely because of the risk of shunt occlusion.
2004, Vol. 3 
