Muhammad Shahzeb Khan1, Muhammad Mustafa Memon2, Emaan Amin2, Naser Yamani3, Safi U Khan4, Vincent M Figueredo5, Salil Deo6, Jonathan D Rich7, Raymond L Benza8, Richard A Krasuski9. 1. Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL. Electronic address: shahzebkhan@gmail.com. 2. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan. 3. Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL. 4. West Virginia University, Morgantown, WV. 5. St Mary Medical Center, Langhorne, PA. 6. Division of Cardiovascular Surgery, University Hospitals, Cleveland, OH. 7. Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL. 8. Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA. 9. Department of Cardiovascular Medicine, Duke University Health System, Durham, NC.
Abstract
BACKGROUND: Despite the use and purported benefits of balloon atrial septostomy (BAS), its safety, efficacy, and therapeutic role in the setting of advanced pulmonary arterial hypertension (PAH) are not well defined. OBJECTIVE: The goal of this study was to conduct a systematic review and meta-analysis to better determine the evidence supporting the use of BAS in PAH. METHODS: MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov were searched from inception through May 2018 for original studies reporting outcomes with PAH prior to and following BAS. Studies comparing BAS vs other septostomy procedures were excluded. Weighted mean differences and 95% CIs were pooled by using a random effects model. RESULTS: Sixteen studies comprising 204 patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis revealed significant reductions in right atrial pressure (-2.77 mm Hg [95% CI, -3.50, -2.04]; P < .001) and increases in cardiac index (0.62 L/min/m2 [95% CI, 0.48, 0.75]; P < .001) and left atrial pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along with a significant reduction in arterial oxygen saturation (-8.45% [95% CI, -9.93, -6.97]; P < .001). The pooled incidence of procedure-related (48 h), short-term (≤ 30 day), and long-term (> 30 days up to a mean follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6% (95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively. CONCLUSIONS: The present analysis suggests that BAS is relatively safe in advanced PAH, with beneficial hemodynamic effects. The relatively high postprocedural and short-term survival with less impressive long-term survival suggest a bridging role for BAS; its contribution to this change needs to be verified by using a comparator group.
BACKGROUND: Despite the use and purported benefits of balloon atrial septostomy (BAS), its safety, efficacy, and therapeutic role in the setting of advanced pulmonary arterial hypertension (PAH) are not well defined. OBJECTIVE: The goal of this study was to conduct a systematic review and meta-analysis to better determine the evidence supporting the use of BAS in PAH. METHODS: MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov were searched from inception through May 2018 for original studies reporting outcomes with PAH prior to and following BAS. Studies comparing BAS vs other septostomy procedures were excluded. Weighted mean differences and 95% CIs were pooled by using a random effects model. RESULTS: Sixteen studies comprising 204 patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis revealed significant reductions in right atrial pressure (-2.77 mm Hg [95% CI, -3.50, -2.04]; P < .001) and increases in cardiac index (0.62 L/min/m2 [95% CI, 0.48, 0.75]; P < .001) and left atrial pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along with a significant reduction in arterial oxygen saturation (-8.45% [95% CI, -9.93, -6.97]; P < .001). The pooled incidence of procedure-related (48 h), short-term (≤ 30 day), and long-term (> 30 days up to a mean follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6% (95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively. CONCLUSIONS: The present analysis suggests that BAS is relatively safe in advanced PAH, with beneficial hemodynamic effects. The relatively high postprocedural and short-term survival with less impressive long-term survival suggest a bridging role for BAS; its contribution to this change needs to be verified by using a comparator group.
Authors: Jane A Leopold; Steven M Kawut; Micheala A Aldred; Stephen L Archer; Ray L Benza; Michael R Bristow; Evan L Brittain; Naomi Chesler; Frances S DeMan; Serpil C Erzurum; Mark T Gladwin; Paul M Hassoun; Anna R Hemnes; Tim Lahm; Joao A C Lima; Joseph Loscalzo; Bradley A Maron; Laura Mercer Rosa; John H Newman; Susan Redline; Stuart Rich; Franz Rischard; Lissa Sugeng; W H Wilson Tang; Ryan J Tedford; Emily J Tsai; Corey E Ventetuolo; YouYang Zhou; Neil R Aggarwal; Lei Xiao Journal: Circ Heart Fail Date: 2021-06-15 Impact factor: 10.447