A new study utilizing data from the EuroTIPS registry may challenge previous beliefs about the relationship between right atrial pressure (RAP) and patient survival after transjugular intrahepatic portosystemic shunt (TIPS) creation.
“Poor heart function may place patients undergoing TIPS at risk for mortality, and cardiac reserve is commonly estimated during TIPS procedures using the right atrial pressure,” said Ron C. Gaba, MD, MS, FSIR, author of one of SIR 2025’s Featured Abstracts, Prognostic Value of Baseline Pre-procedure Right Atrial Pressure for Clinical Outcomes after Transjugular Intrahepatic Portosystemic Shunt Creation: Results from the EuroTIPS Registry.
Dr. Gaba, along with Juan Carlos García-Pagán, MD, PhD, and his research group at the Hospital Clinic, University of Barcelona in Spain, reviewed data from EuroTIPS, a large European TIPS patient registry.
Prior data from the United States suggested that elevated pre-TIPS RAP might predict mortality, leading some to consider it a contraindication for shunt creation. The EuroTIPS registry study aimed to validate these findings in a European cohort.
The study analyzed data from 651 patients who underwent TIPS between 2015 and 2023, examining the impact of various factors, including pre-TIPS RAP, on transplant-free survival (TFS) at 1 year. Dr. Gaba and his team found that the median pre-TIPS RAP was 8 mm Hg and survival rates at 30 days, 6 months and 1 year were 94%, 84% and 76%, respectively. The results further indicated that age, MELD score and RAP were significantly associated with 1-year TFS.
However, according to Dr. Gaba, one of the most interesting findings was that within this dataset, higher RAP exerted a protective effect—which contrasts with previously published data.
“The previous literature shows that higher heart pressures increase mortality risk,” Dr. Gaba said. Taken together, these discordant findings suggest that the current understanding of the topic may be incomplete.
Dr. Gaba emphasizes the need for further analysis to confirm these outcomes, especially as there is limited published data exploring the relationship between RAP and post-TIPS survival.
"As a next step, a more in-depth and rigorous analysis of the study data and results will be necessary to affirm the major outcomes and conclusions drawn before we can publish as a manuscript in a peer-reviewed journal,” he said.
In addition, Dr. Gaba believes there is value in comparing the European data with a U.S. patient cohort to better understand the inconsistent results.
Dr. Gaba will present his findings at SIR 2025 on Sunday, March 30, at 3.p.m. during the Portal Hypertension 1 session.
