Balloon atrial septostomy can improve hemodynamic parameters in patients with advanced pulmonary arterial hypertension (PAH), according to a study published in CHEST.
Researchers completed a systematic review and meta-analysis to report safety, efficacy, and therapeutic benefits of balloon atrial septostomy in patients with PAH. MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov databases were searched for relevant articles that included hemodynamic and clinical outcomes before and after balloon atrial septostomy were performed. Data assessing mean arterial pressure, arterial oxygen saturation, cardiac index, cardiac output, left atrial pressure, mean pulmonary artery pressure, mortality rates, and procedural complications were collected from articles.
In total, 204 patients with PAH from 16 observational studies were included in this analysis. Women made up 73.1% of the study population with a mean age of 35.8 years. Overall, 50.6% had a history of syncope and 53.4% had right heart failure.
In 9 studies, the researchers found that mean right atrial pressure was significantly reduced (mean difference, –2.77 mm Hg; 95% CI, –3.5 to –2.04; P <.001). In 14 studies, cardiac index was significantly increased (mean difference, 0.62 L/min/m²; 95% CI, 0.48-0.75; P <.001). Left atrial pressure was significantly reduced in 6 studies (mean difference, 1.86 mm Hg; 95% CI, 1.24-2.49; P <.001). In 16 studies, arterial oxygen saturation was significantly reduced (mean difference, –8.45%; 95% CI, –9.93 to –6.97; P <.001). In 15 studies, hypoxemia occurred in 3% of patients 48 hours after the procedure, and spontaneous septostomy closure occurred in 23.8% of patients in 9 studies. There was no significant change in mean pulmonary artery pressure as reported in 7 studies. Across all 16 studies, procedure-related mortality occurred in 4.8% of the patients by 48 hours, 14.6% of the patients within 30 days, and 37.7% of the patients in >30 days postprocedure.
A few limitations of this analysis included that none of the studies incorporated a control group, the inability to control confounding variables, and the use of small sample size studies.
“Short-term survival supports its [balloon atrial septostomy] 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,” the researchers concluded.
Disclosures: Dr Krasuski receives research funding from Actelion Pharmaceuticals and has served as an investigator for Edwards Lifesciences, as well as a member of the scientific advisory board for Ventripoint.
Khan MS, Memon MM, Amin E, et al. Use of balloon atrial septostomy in patients with advanced pulmonary arterial hypertension: a systematic review and meta-analysis [published online March 22, 2019]. CHEST. doi:10.1016/j.chest.2019.03.003