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Atrial Septostomy in Patients with Pulmonary Arterial Hypertension

Eric Fenstad

R Le

E. Hardegree

G. Reeder

D. Hagler

A. Cabalka

Garvan Kane

Robert Frantz


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Fenstad E1; Le R2; Hardegree E2; McGoon M1; Reeder G1; Hagler D3; Cabalka A3; Kane G1; Frantz R1

Division of Cardiovascular Diseases1, Department of Internal Medicine2, Division of Pediatric Cardiology3, Mayo Clinic, Rochester, MN, USA.

BACKGROUNDAtrial septostomy (AS) creates an interatrial communication to offload the right ventricle, utilized for Pulmonary Hypertension (PH) in settings where medical therapy is unavailable. Utility in patients with progressive disease despite maximal medical therapy remains incompletely understood.

METHODSSingle center study of all adult PH patients receiving AS at a tertiary PH referral center from 2009-2011. All patients were refractory to medicine and considered for transplant.

RESULTSAtrial septostomy was performed in 8 patients between 2009-2011. Three patients had repeat AS because of re-narrowing of the septostomy, with a mean duration of 220 ± 135 days between procedures. All patients were WHO functional class III/IV with an average age of 40 ± 13 years. Prior to AS, mean RA pressure was 18 ± 4 mm Hg with cardiac index of 2.28 ± 0.82 L/min/m2. Mean pulmonary artery (PA) pressure was 63 mm Hg with an average PA saturation of 48% and average systolic blood pressure of 97 mm Hg. Baseline NT-proBNP was 5573 ± 4589 pg/ml with a mean 6 minute walk distance (6MWD) of 311 ± 131 meters. Five of the 11 procedures resulted in functional class improvement . Functional class change did not relate to 6MWD or NT-pro BNP level. Thirty day mortality was 13%. Mean follow up was 374 ± 315 days. The REVEAL risk scores ranged from 10 to 15, with predicted 1 year survival ranging from 22% to 80% (mean predicted survival of 57%). Actual transplant free survival at 1 year was 63% (5/8).

CONCLUSIONSOne year mortality remains high but not significantly different from that predicted from the REVEAL equation. Selected patients at high risk for 1 year mortality may receive symptomatic benefit from atrial septostomy but further long term investigation is necessary.