Atrial septostomy improves survival in select patients with pulmonary hypertension

Law, Mark A.; Grifka, Ronald G.; Mullins, Charles E.; Nihill, Michael R.

doi:10.1016/j.ahj.2007.02.019

Cited by 82 publications

(67 citation statements)

References 29 publications

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“…Our study series provides the longest follow-up of patients with AS in the setting of PAH and, as in other study series [5,7,27], AS significantly improved long-term survival in these patients. AS improved haemodynamic parameters that correlate with survival (cardiac index and right ventricular filling pressures) and 6MWT, another surrogate of survival in PAH, and this may explain the impact of the procedure on shortterm survival.…”

Section: Effect Of As On Long-term Survivalsupporting

confidence: 74%

“…In most reported series [5,[7][8][9][10][11], AS has been performed only after the failure of different PAH-specific pharmacological interventions. In the present study, patients with concomitant pharmacological treatment had AS performed before pharmacological treatment was initiated.…”

Section: Discussionmentioning

confidence: 99%

“…Other factors, such as the timing of the procedure, may also be important. In the analysis of the collective worldwide experience with AS [6,20] and other reports [7,21], a mean Pra (P ra) of .20 mmHg, a reflection of advanced disease, has been repeatedly identified as the most significant risk factor associated with procedure-related mortality. In a recent communication, MICHELETTI et al [16] reported no fatalities associated with the procedure in 20 children with PAH.…”

Section: Discussionmentioning

confidence: 99%

“…Little information exists regarding the long-term impact of AS on the survival of PAH patients [5][6][7]. In most of the reported series [5,[7][8][9][10][11], the procedure was performed after all available medical therapy failed, late in the course of the disease, when the risk of procedural death is increased and the impact of the intervention on long-term survival is minimised.…”

mentioning

confidence: 99%

“…In most of the reported series [5,[7][8][9][10][11], the procedure was performed after all available medical therapy failed, late in the course of the disease, when the risk of procedural death is increased and the impact of the intervention on long-term survival is minimised. We describe the effect of AS on the survival of a group of patients with PAH in whom the procedure was performed either as an isolated treatment intervention or prior to the use of PAH-specific pharmacological therapy.…”

mentioning

confidence: 99%

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

Sandoval¹,

Gaspar²,

Peña³

et al. 2011

Eur Respir J

119

100

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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.

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Section: Effect Of As On Long-term Survivalsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Sandoval¹,

Gaspar²,

Peña³

et al. 2011

Eur Respir J

119

100

View full text Add to dashboard Cite

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A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension

Troost

Delcroix

Gewillig

et al. 2008

Cathet Cardio Intervent

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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 improves survival in select patients with pulmonary hypertension

Cited by 82 publications

References 29 publications

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

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

A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension

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

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