Long-Term Outcomes in Adult Patients With Pulmonary Hypertension After Percutaneous Closure of Atrial Septal Defects

Abstract

Background: Pulmonary hypertension (PH), recently redefined as mean pulmonary arterial pressure >20 mm Hg (PH 20 ), may be observed in patients with atrial septal defects (ASD). We aimed to determine the effect of preprocedural PH 20 status on outcomes among patients undergoing ASD closure. Methods: Study population was selected from a retrospective registry of adult patients who underwent percutaneous ASD closure from 1998 to 2016 from a single center and had right heart catheterizations during the procedure. The clinical registry was linked to administrative databases to capture short- and long-term outcomes. Results: We included a total of 632 ASD closure patients of whom 359 (56.8%) had PH 20 . The mean follow-up length was 7.6±4.6 years. Patients with PH 20 were older (mean age 56.5 versus 43.1 years, P <0.001) and a higher prevalence of comorbidities including hypertension (54.3% versus 21.6%, P <0.001) and diabetes (18.1% versus 5.9%, P <0.001) than those without PH. In a Cox proportional hazards model after covariate adjustment, patients with PH had a significantly higher risk of developing major adverse cardiac and cerebrovascular events (heart failure, stroke, myocardial infarction, or cardiovascular mortality), with hazards ratio 2.45 (95% CI, 1.4–4.4). When applying the prior, mean pulmonary arterial pressure ≥25 mm Hg (PH 25 ) cutoff, a significantly higher hazard of developing major adverse cardiac and cerebrovascular events was observed in PH versus non-PH patients. Conclusions: ASD patients with PH undergoing closure suffer from more comorbidities and worse long-term major adverse cardiac and cerebrovascular events outcomes, compared with patients without PH. The use of the new PH 20 definition potentially dilutes the effect of this serious condition on outcomes in this population.

Long-Term Survival of Adult Patients With Atrial Septal Defect With Regards to Defect Closure and Pulmonary Hypertension

“…Our study confirmed that ASD patients with PH had higher mortality and suffered more often from mitral and tricuspid regurgitation and arrhythmias, compared to patients without PH. This is in line with the literature; patients with PH had more comorbidities, were older and had a significantly higher risk of developing major cardiac and cerebrovascular adverse events after transcatheter ASD closure ( 25 ).…”

Normalization of Four Different Types of Pulmonary Hypertension After Atrial Septal Defect Closure

“…Pulmonary hypertension (PH) represents an important risk factor associated with reduced functional capacity and increased mortality in patients with atrial septal defect (ASD) (1)(2)(3)(4)(5)(6). Moreover, persistence of PH after ASD closure is strongly associated with increased mortality (4,7,8).…”

Percutaneous atrial septal defect closure in patients with pulmonary arterial hypertension

“…The optimal management of patients with ASD and PAH is controversial [2,3]. When the PAH is severe, surgical closure has produced poor outcomes [4][5][6], whereas transcatheter closure after lung transplantation (transplant-and-repair strategy) has been found beneficial [7].…”

“…The 2022 ESC/ERS guidelines stipulate that ASD closure should be considered only when pulmonary vascular resistance (PVR) is below 5 Wood units (WU) [3]. However, transcatheter shunt closure seems possible in selected patients with higher PVR values, particularly after PAH-specific treatment (PAHST) (treat-and-repair strategy), although the data come only from small cohorts and current recommendations rely primarily on expert opinion [6,[8][9][10]. Prospective studies are needed to further assess this strategy.…”