Impact of Pulmonary Hypertension on Survival Following Device Closure of Atrial Septal Defects

Ranard, Lauren S.; Mallah, Wael El; Awerbach, Jordan D.; Abernethy, Abraham; Halane, Mohamed; Qureshi, Athar M.; Krasuski, Richard A.

doi:10.1016/j.amjcard.2019.07.042

Cited by 8 publications

(17 citation statements)

References 30 publications

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“…This study also stated that survival in this group was similar to survival of idiopathic PAH and was significantly worse compared to patients with PAH-small shunts and Eisenmenger syndrome [ 8 ]. Similar results were found by Ranard, et al (2019), who reported that patients with persistence of PAH at the three-month follow-up had increased risk of mortality compared with patients that had resolution of PAH [ 27 ].…”

Section: Discussionsupporting

confidence: 85%

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Arafuri

Murni

Idris

et al. 2021

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Background: In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods: All cases of PAH related to left-to-right shunt CHD repairs from 2015–2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019–2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth’s correction and restricted mean survival time were used for survival analysis. Results: Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m 2 ). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had –476.1 days (95% confidence interval [CI]: –714.4, –237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion: In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.

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Section: Discussionsupporting

confidence: 85%

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Arafuri

Murni

Idris

et al. 2021

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“…Here, we conducted a retrospective study comparing long-term mortality in ASD patients with and without defect closure, with respect to PH, age, and other clinical variables. In line with previous studies ( 3 , 4 ), we observed PH to be associated with higher all-cause mortality. The frequency of PH was high in our cohort (44%).…”

Section: Discussionsupporting

confidence: 93%

“…The decision concerning ASD closure is particularly difficult in elderly patients with PH given the increased mortality risk in this group after ASD closure compared to young patients or patients without PH ( 3 , 4 , 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…The previous studies were missing a control group of patients without ASD closure, and thus could not distinguish whether the worsened survival is due to ASD closure itself, or PH and older age ( 3 ). Other previous studies have indicated that older patients with moderate or severe PH benefit from transcatheter closure of ASD with regards to improvement of symptoms and reduction of PH; however, these studies did not report a survival analysis ( 9 , 13 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…ASD closure appears safe in young patients without PH or even with PH meeting the criteria for defect closure ( 2 – 6 ). However, the presence of PH in older patients is associated with increased mortality following ASD closure compared to patients without PH ( 3 , 4 ). It is not known whether the poor prognosis of the PH patients results from the ASD closure itself, or if their outcome would have been similar or even worse if the ASD closure was not carried out.…”

Section: Introductionmentioning

confidence: 99%

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

Popelová

Tomková

Tomek

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAtrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD.MethodsA retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18–56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9–31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival.ResultsDefect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03).ConclusionASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.

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Secundum Atrial Septal Defects Transcatheter Closure: An Updated Reappraisal

Rigatelli

Gianese

Zuin

2022

Cardiovascular Revascularization Medicine

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Impact of Pulmonary Hypertension on Survival Following Device Closure of Atrial Septal Defects

Cited by 8 publications

References 30 publications

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

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

Secundum Atrial Septal Defects Transcatheter Closure: An Updated Reappraisal

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