Abstract 13341: Comparison of Graded Balloon Atrial Septostomy to Continued Medical Therapy or Novel Interventional Techniques in Patients With Advanced Pulmonary Arterial Hypertension

• Published in: Circulation (New York, N.Y.) Vol. 138; no. Suppl_1 Suppl 1; p. A13341
• Main Authors: Khan, Muhammad S, Sreenivasan, Jayakumar, Memon, Muhammad M, Amin, Emaan, Ochani, Rohan K, Shaikh, Asim, Fatima, Kaneez, Asmi, Nisar, 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 ESC/ERS Pulmonary Arterial Hypertension (PAH) Guidelines recommend graded balloon atrial septostomy (BAS) as the technique of choice for advanced PAH patients requiring BAS. We performed a systematic review of prior studies to examine this issue further.MethodsMEDLINE, Scopus, Cochrane Library and Clinicaltrials.gov were searched for original studies comparing BAS to either standard medical therapy or other atrial septostomy (AS) procedures in PAH patients from database origination dates until May 2018. Review articles, case reports and letters were excluded. Safety outcomes included mortality and peri-procedural complications.ResultsFive studies involving 68 patients (mean age 23.4 years and 58.1% women) were included. Comparative procedures in three studies included blade AS, blade and balloon AS, and fenestrated Amplatzer Septal Occluder Device implantation. Two studies compared BAS with ongoing medical management. The pooled incidence of short (≤1 month) and long (>1 month) term mortality after BAS was 15.2% and 18.2% respectively, compared to 4.2% and 12.5% with the alternative interventions and 0% and 9.1% with standard medical therapy. The most common procedural complication of BAS was low output syndrome (6.1%).ConclusionsGraded BAS appears to have higher short and mid-term mortality rates compared with alternative forms of AS and medical therapy alone. Further studies are needed to examine potentially safer interventional options for unloading the right heart in PAH and to determine whether BAS should remain the preferred technical approach.