Chest
Original Research: Pulmonary Vascular DiseaseUse of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis
Section snippets
Data Sources and Search Strategy
This systematic review was conducted in accordance with the Preferred Reporting Items of Systematic Review and Meta-Analysis reporting standards.5 MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov were searched from inception through May 2018 for original articles reporting outcomes in patients with PAH prior to and following BAS. No restrictions were placed with respect to time of publishing. Only articles in English were considered. The complete list of search terms used in each
Results
The literature search process is detailed in the PRISMA flowchart (Fig 1). Sixteen noncomparative observational studies comprising 204 patients with PAH were included in the final analysis (Table 1).1, 4, 11, 14, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 All individual studies had small (n < 35) sample sizes. The mean age of patients ranged from 6 to 56 years. On average, studies consisted of a majority (73.1%) of women with a history of syncope (50.6%) and RHF (53.4%) as the most commonly
Discussion
This comprehensive systematic review and meta-analysis comprising 212 patients with PAH found that BAS significantly improved important hemodynamic parameters, namely RAP, LAP, and the cardiac index, while also resulting in a reduction in Sao2. The interpretation of mortality rates associated with BAS is challenging because of the high-risk patient population and the absence of randomized or comparative studies as part of the meta-analysis. Despite these issues, approximately 50% of patients
Conclusions
BAS seems to be a relatively safe procedure associated with largely favorable hemodynamic outcomes in carefully selected patients with PAH. Short-term survival supports its consideration as a bridging procedure (ie, to lung transplantation), and longer term survival may rival contemporary medical treatments in patients with advanced stages of this uniformly fatal disease.
Acknowledgments
Author contributions: M. S. Khan: Study inception, study design, data interpretation, and critical review; M. M. M. and E. A.: Study inception, study design, literature search, data collection, statistical analysis, figure creation, data interpretation, writing, and critical review; N. Y., S. U. Khan, V. M. F., S. D., J. D. R., R. L. B., and R. A. K.: Study design, data interpretation, writing, and critical review.
Financial/nonfinancial disclosures: The authors have reported to CHEST the
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Cited by (38)
Treatment of pulmonary arterial hypertension: recent progress and a look to the future
2023, The Lancet Respiratory MedicineOutcomes of atrial septostomy and effect on long-term survival in patients with idiopathic pulmonary arterial hypertension: A single-center cohort
2023, International Journal of CardiologyCitation Excerpt :Since the first report of septostomy in PAH 30 years ago [15], BAS is used to alleviate RHF symptoms and/or syncope [7,16]. Despite the use and purported benefits of BAS [17,18], it remains a palliative and invasive therapy. In our present study, we substantiated the hemodynamic benefits of BAS, including a decrease in RAP of usually by 2–3 mmHg, a proportional increase in LAP despite a decrease in SaO2, and, more importantly, a 30–35% increase in CI.
Successful recovery after blade atrial septostomy in a child with pulmonary hypertensive crisis and cardiac arrest requiring extracorporeal cardiopulmonary resuscitation
2022, Progress in Pediatric CardiologyCitation Excerpt :Atrial septostomy is a well-described procedure for LV decompression to reduce pulmonary edema, prevent pulmonary hemorrhage, and reduce LV distention that may aid in the recovery of function while on ECMO [7]. In adult patients with severe pulmonary hypertension and RV failure, atrial septostomy is used as a “bridging” therapy to lung transplantation or palliative therapy to decrease symptoms when there is no response to medical treatment [8]. Pulmonary hypertension patients with recurrent syncope and World Health Organization functional class III and IV symptoms improve after atrial septostomy because of increased cardiac output [9].
Percutaneous Treatments for Pulmonary Hypertension: Reviewing the Growing Procedural Role for Interventional Cardiology
2022, Interventional Cardiology ClinicsAdvanced Circulatory Support and Lung Transplantation in Pulmonary Hypertension
2022, Cardiology ClinicsCitation Excerpt :The authors cited procedural experience at a high volume center as a reason for the reason for no procedural deaths and suggested that balloon trial septostomy could be a therapeutic option in properly selected patients. A recent meta-analysis of 16 balloon atrial septostomy studies including 212 patients total revealed that atrial septostomy was effective in reducing right atrial pressure and increasing cardiac index, while reducing systemic O2 saturations an average of 8.5%.52 Procedural and 30-day mortality were 4.8% and 14.6%, whereas long-term mortality (mean follow-up of 46.5 months) was 38%.
The abstract of this study was presented at the American Heart Association Scientific Sessions, November 10-12, 2018, Chicago, IL.
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.