Abstract
Background: Prostanoid therapy improves quality of life and may increase survival in patients with advanced pulmonary hypertension (PH). Balloon atrial septostomy (BAS) can palliate or a serve as a bridge to transplantation for patients resistant to medical therapy. The safety and efficacy of BAS in the era of prostanoid therapy has not previously been reported. Methods: All patients had progressive symptoms despite prostanoid therapy at the time of their first BAS. Eleven patients who underwent a total of 16 septostomies between 2004-11 were included in this retrospective analysis. Results: Baseline demographics are shown in Table 1. Survival at a mean of 739 days was 73%. No patient died within 24 hours post-procedure. Thirty-day and 1-year survival were both 82%. 4 subjects required repeat BAS due to shunt closure; 3 subjects were successfully bridged to transplant. 9 of 11 patients had improvement by one functional class. Hemodynamic and echocardiographic measurements are presented in Table 2. All non-survivors were male and had higher baseline serum creatinine, mean right atrial pressure, right ventricular (RV) end diastolic pressure and left ventricular filling pressures, and lower RV ejection fraction. Mortality was associated with unchanged post-septostomy cardiac output despite an increase in LVEDP. Tricuspid annular plane systolic excursion (TAPSE) and serum BNP were not different between the two groups. Conclusions: BAS appears to be a promising therapy for select PH patients who have symptomatic progression despite prostanoid therapy. Survival is comparable to prior reports of patients undergoing BAS in the pre-prostanoid era.
Published Version
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