P64 Heart failure outcomes following transjugular intrahepatic portosystemic shunts

<h3>Background/Aims</h3> Transjugular intrahepatic portosystemic shunts (TIPSS) are increasingly used for the management of variceal bleeding and diuretic refractory ascites. Complications include cardiac failure in up to 20%. TIPSS outcomes over a 12-year period were reviewed for predictors of the occurrence of heart failure. <h3>Method</h3> Data was collated retrospectively for TIPSS performed at a tertiary referral centre between 2010 and 2022. The primary outcome was the occurrence of heart failure. Referring hospitals were contacted and information requested for data missing up to 12 month follow up. Statistical analysis included Mann-Whitney and t-tests for comparison of continuous variables between groups and binary logistic regression to determine predictive factors for the occurrence of heart failure. <h3>Results</h3> 472 patients underwent TIPSS, including 279 for ascites and 193 patients for variceal bleeding. Overall, 65% of patients were male and the mean age was 55 years. The most common aetiology was alcohol at 64%, 13% were due to metabolic dysfunction-associated steatotic liver disease and 8% were secondary to hepatitis C infection. Heart failure was documented in 80/472 (16.9%). Similar proportions of patients developed heart failure between the two groups, 48/279 (17.2%) in the ascites cohort and 32/193 (16.5%) in the variceal bleeding cohort. In 57.5% (46/80) heart failure was detected in the outpatient setting, most commonly due to new onset peripheral oedema, and was successfully managed with outpatient diuretic therapy. 10% (8/80) required re-admission to hospital for fluid overload (3% of the overall cohort). Five patients had multi-system involvement driving their symptoms as opposed to solely the TIPSS. Two patients required haemodialysis for fluid removal before subsequently undergoing TIPSS reductions as definitive management. Univariate analysis demonstrated the clinical factors of age and cryptogenic cirrhosis to be significant factors for heart failure, remaining independently predictive at multivariable analysis (Age: aOR 1.024, 95% C.I 1.001- 1.049, cryptogenic cirrhosis: aOR 2.979, 95% C.I 1.118–7.937). Cardiac risk factors were not predictive in this cohort. 82 patients had a pro-BNP within 6 months of their TIPSS, with no overall significant baseline increase in those who developed heart failure however, in the diuretic-refractory ascites cohort, the median baseline pro-BNP value was statistically higher in those with heart failure. <h3>Conclusion</h3> The majority of heart failure following TIPSS procedures is manageable in an outpatient setting and does not require re-admission to hospital or intervention beyond diuretic therapy. Cardiovascular risk factors did not predict the risk of heart failure in this cohort.