Abstract 12378: Meta-Analysis of Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A12378
• Main Authors: Khan, Muhammad S, Memon, Muhammad M, Amin, Emaan, Khan, Safi U, Fatima, Kaneez, Lateef, Noman, Figueredo, Vincent, Benza, Raymond L, Krasuski, Richard
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 06-11-2018
• ISSN: 0009-7322; 1524-4539

IntroductionThe safety, efficacy and therapeutic role of balloon atrial septostomy (BAS) in the setting of advanced pulmonary arterial hypertension (PAH) remain uncertain. We conducted a systematic review and meta-analysis in order to gain further insight.MethodsMEDLINE, Scopus, Cochrane Library and Clinicaltrials.gov were searched for original studies reporting outcomes in PAH patients before and after BAS from times of database initiation through May 2018. Studies comparing BAS to other septostomy procedures were excluded. Weighted mean differences (WMDs) and 95% confidence intervals were pooled using a random effects model. Multivariate random effects meta-regression analysis was performed for key outcomes using mean age, sex, syncopal history and idiopathic-type PAH as confounding factors.ResultsSixteen studies comprising of 204 patients (mean age 35.8 years and 73.1% women) were included. Meta-analysis revealed significant reductions in right atrial pressure (-2.77 mmHg [95% CI -3.50, -2.04]; p<0.001) and arterial oxygen saturation (-8.45% [-9.93, -6.97]; p<0.001), while a significant increase in cardiac index (0.62 l/min/m2 [0.48, 0.75]; p<0.001) and left atrial pressure (1.86 mmHg [1.24, 2.49]; p<0.001) was observed following BAS (Figure). The pooled incidence of procedure related (48hr), short-term (≤30 day) and long term (>30 days) mortality was 4.9%, 12.3% and 37.3% respectively. The most common pooled procedural complication was refractory hypoxemia (3.9%).ConclusionOur analysis suggests that BAS is relatively safe in advanced PAH with beneficial hemodynamic effects. Mid-term survival unfortunately remains poor, suggesting at best a bridging role for BAS.