PT  - JOURNAL ARTICLE
AU  - J. Sandoval
AU  - J. Gaspar
AU  - H. Peña
AU  - L.E. Santos
AU  - J. Córdova
AU  - K. del Valle
AU  - A. Rodríguez
AU  - T. Pulido
TI  - Effect of Atrial Septostomy on the Survival of Patients with Severe Pulmonary Arterial Hypertension
AID  - 10.1183/09031936.00072210
DP  - 2011 Jan 01
TA  - European Respiratory Journal
PG  - erj00722-2010
4099  - http://erj.ersjournals.com/content/early/2011/02/24/09031936.00072210.short
4100  - http://erj.ersjournals.com/content/early/2011/02/24/09031936.00072210.full
AB  - Atrial septostomy (AS) is a palliative treatment for right ventricular failure from severe pulmonary arterial hypertension (PAH). We sought to investigate the effect of AS, alone or combined with PAH-specific pharmacotherapy, on the survival of patients with PAH.We performed a retrospective analysis of the functional and hemodynamic changes in patients with PAH following AS and of long-term survival characteristics for the whole group and separately for the subgroup who received post-procedural pharmacotherapy.Fifty procedures performed in 34 patients (age: 35±10 years) resulted in hemodynamic and symptomatic improvement in most. Only one procedure-related death occurred (2%). Due to spontaneous closure of the defect, AS was repeated in 10 patients. In 21 patients, AS was the only form of treatment while eleven received additional pharmacotherapy after AS. During follow-up (mean 58.5±38 months) 21 patients died; median survival of the group was 60 months (95%CI, 43 to 77). Median survival for patients on pharmacotherapy additional to AS was 83 months (95%CI, 57 to 109) which is better than that for patients with AS alone [53 months (95%CI, 39 to 67); log-rank, 6.52; p=0.010].Conclusions: In selected patients with PAH, AS is a safe and effective intervention that exerts a beneficial impact on long-term survival. The survival appears to be improved when AS is combined with PAH-specific pharmacotherapy.