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Meta-Analysis
. 2019 Jul;156(1):53-63.
doi: 10.1016/j.chest.2019.03.003. Epub 2019 Mar 23.

Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis

Muhammad Shahzeb Khan  1 , Muhammad Mustafa Memon  2 , Emaan Amin  2 , Naser Yamani  3 , Safi U Khan  4 , Vincent M Figueredo  5 , Salil Deo  6 , Jonathan D Rich  7 , Raymond L Benza  8 , Richard A Krasuski  9
Affiliations
Meta-Analysis

Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis

Muhammad Shahzeb Khan et al. Chest. 2019 Jul.

Abstract

Background: Despite the use and purported benefits of balloon atrial septostomy (BAS), its safety, efficacy, and therapeutic role in the setting of advanced pulmonary arterial hypertension (PAH) are not well defined.

Objective: The goal of this study was to conduct a systematic review and meta-analysis to better determine the evidence supporting the use of BAS in PAH.

Methods: MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov were searched from inception through May 2018 for original studies reporting outcomes with PAH prior to and following BAS. Studies comparing BAS vs other septostomy procedures were excluded. Weighted mean differences and 95% CIs were pooled by using a random effects model.

Results: Sixteen studies comprising 204 patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis revealed significant reductions in right atrial pressure (-2.77 mm Hg [95% CI, -3.50, -2.04]; P < .001) and increases in cardiac index (0.62 L/min/m2 [95% CI, 0.48, 0.75]; P < .001) and left atrial pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along with a significant reduction in arterial oxygen saturation (-8.45% [95% CI, -9.93, -6.97]; P < .001). The pooled incidence of procedure-related (48 h), short-term (≤ 30 day), and long-term (> 30 days up to a mean follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6% (95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively.

Conclusions: The present analysis suggests that BAS is relatively safe in advanced PAH, with beneficial hemodynamic effects. The relatively high postprocedural and short-term survival with less impressive long-term survival suggest a bridging role for BAS; its contribution to this change needs to be verified by using a comparator group.

Keywords: balloon atrial septostomy; efficacy; meta-analysis; pulmonary arterial hypertension; safety.

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Figures

Figure 1
Figure 1
Literature search process outlined according to Preferred Reporting Items of Systematic Review and Meta-Analysis flow diagram. PAH = pulmonary arterial hypertension.
Figure 2
Figure 2
Asymmetrical funnel plot indicating evidence of publication bias. MD = mean difference.
Figure 4
Figure 4
Forest plot outlining mean difference in mean RAP following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations.
Figure 6
Figure 6
Forest plot outlining mean difference in mean PAP following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations.
Figure 7
Figure 7
Forest plot outlining mean difference in MAP following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations.
Figure 8
Figure 8
Forest plot outlining mean difference in LAP following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations
Figure 9
Figure 9
Forest plot outlining mean difference in mean Sao2 following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations.
Figure 5
Figure 5
Forest plot outlining mean difference in mean cardiac index following BAS compared with prior to BAS. See Figure 3 legend for expansion of abbreviations.
Figure 3
Figure 3
Summary of results of meta-analysis. BAS = balloon atrial septostomy; LAP = left atrial pressure; MAP = mean arterial pressure; PAP = pulmonary artery pressure; RAP = right atrial pressure; RHF = right-sided heart failure; Sao2 = arterial oxygen saturation.
See this image and copyright information in PMC

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