Selection of Patients for Portal-Systemic Shunts

The proper selection of patients for portal-systemic shunts is essential for maximum survival and benefit to be achieved. The factors associated with increased mortality in 76 shunt procedures during the last 17 years at the Cleveland Clinic are poor hepatic function, urgent surgery, increasing age of the patient, and certain pathological types of cirrhosis. The type of shunt performed has not clearly influenced survival. The overall operative (30 days) mortality has been 26%; the five-year survival rate is 45%. The major cause of death after portalsystemic shunt is progressive hepatic failure. In a selected group of patients with cirrhosis of the liver and good hepatic function, who were less than 55 years of age, in whom elective portacaval shunt was performed, the operative (30 days) mortality was 12%.