Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension

Abstract

Atrial septostomy (AS) is a palliative treatment for right ventricular failure from severe pulmonary arterial hypertension (PAH). We sought to investigate the effect of AS, alone or combined with PAH-specific pharmacotherapy, on the survival of patients with PAH.We performed a retrospective analysis of the functional and haemodynamic changes in patients with PAH following AS, and long-term survival characteristics for the whole group and separately for the subgroup who received post-procedural pharmacotherapy. 50 procedures performed in 34 patients (mean¡SD age 35¡10 yrs) resulted in haemodynamic and symptomatic improvement in most of the patients. Only one (2%) procedure-related death occurred. Due to spontaneous closure of the defect, AS was repeated in 10 patients. In 21 patients, AS was the only form of treatment, while 11 received additional pharmacotherapy after AS. During follow-up (58.5¡38 months), 21 patients died; median survival of the group was 60 months (95% CI 43-77 months). Median survival for patients on pharmacotherapy additional to AS was 83 months (95% CI 57-109 months), which was better than that for patients with AS alone (53 months, 95% CI 39-67 months) (log-rank 6.52; p50.010).In selected patients with PAH, AS is a safe and effective intervention that exerts a beneficial impact on long-term survival. Survival appears to be improved when AS is combined with PAHspecific pharmacotherapy.

Optimal management of severe pulmonary arterial hypertension

“…Another potential strategy to improve outcome is to use BAS in combination with PAH-specific therapies. A recent study of 34 patients with severe PAH treated with BAS reported haemodynamic and symptomatic improvement in most patients, with significantly better survival in those patients who also received PAH-specific therapies compared with those who received BAS alone (median 83 months, 95% CI 57-109 months versus 53 months, 95% CI 39-67 months, respectively; p50.010) [54].…”

Baloon atrial septostomy in pulmonary arterial hypertension: Atrial flow regulator — New therapeutic option

“…In line with other reports, there was a significant increase in cardiac index, resulting in an increase in systemic oxygen transport [2][3][4]. Unfortunately, a subsequent size reduction or spontaneous closure of the defect has been observed in many reports requiring repeat BAS procedures [5,6]. To avoid this problem, Micheletti et al [7] implanted a custom-made fenestrated atrial septal device at the conclusion of BAS procedure to maintain the atrial septum opened.…”

Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease

“…Guidelines do not comment on atrioseptostomy in the case of RV overload in PH-CHD. However, this procedure is described in other types of pulmonary arterial hypertension with acceptable results [21,22]. The procedure resulted in enhanced systemic oxygen delivery and short-term clinical improvement.…”