Controlled underdilation using novel Viatorr controlled expansion stents improves survival after transjugular intrahepatic portosystemic shunt implantation

ABSTRACT BACKGROUND and AIMS Smaller 8 mm diameter transjugular intrahepatic portosystemic shunts (TIPS) seem to be more beneficial than larger 10 mm TIPS stent-grafts, but lack the ability to secondary dilation in case of clinical ineffectiveness. Underdilated Viatorr TIPS stent-grafts (VTS) expand passively, while novel Viatorr Controlled Expansion (VCX) stent-grafts does not. This study evaluates the impact on survival of underdilated VCX in comparison to VTS in patients with decompensated liver cirrhosis. METHODS Prospective case-control study including cirrhotic patients receiving TIPS using 10 mm VCX underdilated to 8 mm. Cirrhotic patients 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, 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 to VTS at 9.9 (9.7-10.0) mm (p CONCLUSIONS This study demonstrates that VCX stent-grafts underdilated to 8 mm do not passively expand to nominal diameter and suggests reduced hospital readmissions due to hepatic encephalopathy, uncontrolled ascites and heart failure, and improve 1-year survival compared to underdilated VTS. ClinicalTrials.gov Identifier NCT03628807.