Atrial Septostomy and Transplantation for Patients with Pulmonary Arterial Hypertension

Corris, Paul A.

doi:10.1055/s-0029-1233318

Cited by 12 publications

(5 citation statements)

References 53 publications

(65 reference statements)

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“…This pragmatic approach is supported by our review of the published experience and by similar analyses performed by others [46,47,52]. Patients with a right atrial pressure of >20 mmHg have a significantly increased risk of developing severe hypoxemia and statistically have an approximately tenfold increased risk of death within 24 h of the procedure.…”

Section: Mixed Venous Oxygen Saturation (%)supporting

confidence: 56%

“…Some of the deaths occurred hours after the procedure and therefore we decided to investigate the 24-h mortality. Some investigators have opted for 30-day mortality [46,47], but we chose not to do so because some critically ill patients needing AS have a high risk of A high right atrial pressure, low cardiac index, and a high pulmonary vascular resistance index and mean pulmonary arterial pressure were identified as significant risk factors for early mortality ( • Left ventricular end-diastolic pressure >18 mmHg [47,52];…”

Section: Mixed Venous Oxygen Saturation (%)mentioning

confidence: 99%

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Atrial septostomy in patients with pulmonary hypertension: should it be recommended?

Lammers

Haworth

Diller

2011

Expert Review of Respiratory Medicine

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Treatment options for patients with advanced pulmonary hypertension (PH) are limited. Iatrogenic creation of an interatrial communication (i.e., atrial septostomy [AS]) has been suggested as a possible treatment option or as a bridge to transplantation in selected patients and has been incorporated into current PH guidelines. Uptake of the procedure has been slow and the worldwide experience with AS is limited to approximately 280 published cases, over a period of more than 25 years. The rationale for creating an AS has been provided by the observation that patients with congenital heart disease, shunt lesions and PH have a better survival compared with patients with idiopathic PH. We review pathophysiologic data and the published clinical experience and discuss the rationale, indication and potential pitfalls of AS in patients with severe PH.

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Section: Mixed Venous Oxygen Saturation (%)supporting

confidence: 56%

Section: Mixed Venous Oxygen Saturation (%)mentioning

confidence: 99%

Atrial septostomy in patients with pulmonary hypertension: should it be recommended?

Lammers

Haworth

Diller

2011

Expert Review of Respiratory Medicine

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“…Although atrial septostomy may be appropriate to consider in select patients refractory to maximal medical therapy, the procedure lacks robust study in randomized clinical trials, with data limited to single-center experiences. [16][17][18][19] Perhaps more important is the concept that PC can coexist with aggressive PAH treatment, including interventional and surgical procedures, and may be adjunctive to symptom control, particularly when advanced therapies are involved. 15,20,21 In our study, we aimed to identify physician-perceived potential barriers to PC involvement in the care of patients with PAH.…”

Section: Discussionmentioning

confidence: 99%

Physician Attitudes toward Palliative Care for Patients with Pulmonary Arterial Hypertension: Results of a Cross‐Sectional Survey

et al. 2014

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Pulmonary arterial hypertension (PAH) is a chronic, symptomatic, life-threatening illness; however, it is complex, with variable expression regarding impact on quality of life (QOL). This study investigated attitudes and comfort of physicians regarding palliative care (PC) for patients with PAH and explored potential barriers to PC in PAH. An internet-based, mixed-methods survey was distributed to Pulmonary Hypertension Clinicians and Researchers, a professional organization within the Pulmonary Hypertension Association. Only responses from physicians involved in clinical care of patients with PAH were analyzed. Of 355 clinicians/researchers, 79 (22%) returned surveys, including 76 (21%) providers involved in clinical care. Responding physicians were mainly pulmonologists (67%), practiced in university/academic medical centers (89%), had been in practice a mean of 12 AE 7 years, cared for a median of 100 PAH patients per year, and reported a high level of confidence in managing PAH (87%), advanced PAH-specific pharmacologic interventions (95%), and end-of-life care (88%). Smaller proportions were comfortable managing pain (62%) and QOL issues (78%). Most physicians (91%) reported utilizing PC consultation at least once in the prior year, primarily in the setting of end-of-life/active dying (59%), hospice referral (46%), or symptomatic dyspnea/impaired QOL (40%). The most frequent reasons for not referring patients to PC included nonapproval by the patient/family (51%) and concern that PC is "giving up hope" (43%). PAH may result in symptoms that impair QOL despite optimal PAH therapy; however, PC awareness and utilization for PAH providers is low. Opportunities may exist to integrate PC into care for PAH patients.

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“…Beyond medical therapy consisting mainly of prostacyclin analogues and phosphodiesterase type 5 (PDE‐5) inhibitors, atrial septostomy (AS) has been used as a high‐risk therapeutic option in symptomatic, drug‐refractory patients with pulmonary hypertension . However, the precise role of AS in the treatment of pulmonary hypertension remains uncertain because only small series have been reported.…”

Section: Introductionmentioning

confidence: 99%

Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

Weimar

Watanabe

Kazui

et al. 2012

Cathet Cardio Intervent

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Objectives This study aimed at identifying the ideal right-to-left shunt-fraction to improve cardiac output (CO) and systemic perfusion in pulmonary arterial hypertension (PHT). Background Atrial septostomy has been a high-risk therapeutical option for symptomatic drug-refractory patients with PHT. Results have been unpredictable due to limited knowledge of the optimal shunt-quantity. Methods In 9 dogs, an 8-mm shunt-prosthesis was inserted between the superior vena cava (SVC) and the left atrium. With pulmonary artery banding, mean (±SEM) systolic right ventricular pressure increased from 37±1 mmHg at baseline to 44±1 mmHg (moderate PHT, P=0.005) and 50±2 mmHg (severe PHT, P<0.001). Shunt-flow was adjusted by total (forcing all flow through the shunt) or partial occlusion of the SVC and partial or total clamping of the shunt. Caval-, shunt- and aortic-flow were measured by ultrasonic flow-probes. Blood gases were drawn from the aortic root and pulmonary artery. Results At severe PHT, a shunt-flow of 11±1% of CO (253±90 mL/min) increased CO significantly by 25% (1.8±0.1 to 2.4±0.2 L/min, P=0.005) causing an increase of systemic oxygen delivery index (DO2I) by 23% (309±23 to 399±32 mL/min/M2, P=0.035). Arterial O2-saturation did not change significantly until a shunt-flow of 18±2% was exceeded, causing a drop from 96±1% to 84±4% (P=0.013). At moderate PHT, CO or DO2I did not improve significantly at any shunt-flow. Conclusions In severe PHT, a shunt-flow of 11% of CO represented the ideal shunt-fraction. Augmentation of CO compensated for declined O2-saturation due to right-to-left shunting and improved DO2I. In moderate PHT, atrial septostomy is less promising.

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Atrial Septostomy and Transplantation for Patients with Pulmonary Arterial Hypertension

Cited by 12 publications

References 53 publications

Atrial septostomy in patients with pulmonary hypertension: should it be recommended?

Atrial septostomy in patients with pulmonary hypertension: should it be recommended?

Physician Attitudes toward Palliative Care for Patients with Pulmonary Arterial Hypertension: Results of a Cross‐Sectional Survey

Impact of differential right‐to‐left shunting on systemic perfusion in pulmonary arterial hypertension

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