Abstract
The aim of this study was to analyze results of stenting atrioseptostomy in patients with pulmonary arterial hypertension and a different level of risk for one-year mortality that is not well described. Patients that underwent atrioseptostomy with stenting were retrospectively divided in two groups: “intermediate” (n = 55) or “high” risk (n = 13), according to the 2015 ESC/ESR guideline. Results of atrioseptostomy were assessed during hospital period and at follow-up. Patients from “intermediate” risk group demonstrated lower mortality rate (10/55, vs. 6/13) during the course of the study period, as well as higher freedom from lung transplantation or Potts shunt. At discharge, patients of both groups presented improvement in functional class and mobility. Patients from “intermediate” risk group showed longer 6-min walking distance, and lower levels of brain natriuretic peptide. At the latest follow-up, stable position and full patency of stents with right-to-left or bidirectional shunt at atrial level and absence of syncope was confirmed in patients of both groups. Patients from the “intermediate” risk group demonstrated higher functional class, better performance of walking test, and lower levels of brain natriuretic peptide. Stenting atrioseptostomy reliably secured interatrial communication and improved clinical condition in patients with idiopathic pulmonary arterial hypertension. Mid-term results were better in “intermediate” risk group.
Highlights
Idiopathic pulmonary arterial hypertension (PAH) is a severe disease that often quickly progresses and leads to fatal outcomes
Clinical signs of right heart failure were recorded in all patients of the “high risk” group
Patients in the “high risk” group were in a worse World Health Organization (WHO) functional class and demonstrated inferior performance of 6MWD test, as well as significantly lower SaO2 after the test (Table 2)
Summary
Idiopathic pulmonary arterial hypertension (PAH) is a severe disease that often quickly progresses and leads to fatal outcomes. According to current PAH treatment recommendations, AS can be considered for patients in III–IV functional class with syncope and/or severe right ventricular failure that is refractory to maximal drug therapy, or if this therapy is not available [1]. The main rationale for AS in PAH is creating and maintaining atrial septal communication with right-to-left shunting that can achieve decompression of the right cardiac chambers, as well as increase the preload of the left chambers, but with no development of severe hypoxemia. Results of atrial septostomy in patients with different levels of risk are not well described
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