title: Balloon atrial septostomy in pulmonary arterial hypertension: effect on survival and associated outcomes.
abstract: BACKGROUND
  Pulmonary arterial hypertension (PAH) is a progressive disease that, without early identification and treatment, may lead to right heart failure, multi-organ dysfunction and early death. In severe PAH, in addition to maximal medical therapy, balloon atrial septostomy (BAS) may be used for palliation and as a bridge to lung transplantation. We present our contemporary institutional experience utilizing BAS in adult and pediatric patients with severe PAH.
  
  
  METHODS
  We performed a retrospective analysis of 46 BASs performed in 32 patients with PAH from 2002 to 2013. Data obtained included vital status, functional class, medications, hemodynamic measurements from right heart catheterizations and biomarkers. Lung transplantation-free and repeat-BAS-free survival was analyzed.
  
  
  RESULTS
  Median age at BAS was 23 (range 1 to 56) years. The most common indications were symptomatic right heart failure (21 of 46 patients) and pre-syncope/syncope (19 of 46 patients); 69% of patients were WHO Functional Class III or IV pre-BAS. There were no procedural complications or deaths. There were no significant differences in biomarkers or hemodynamic findings between pre-BAS and 1 year or latest follow-up. Seven patients were successfully bridged to lung transplantation. Lung transplantation-free and repeat-BAS-free survival at 30 days, 1 year and 5 years was 87%, 61% and 32%, respectively.
  
  
  CONCLUSIONS
  In our experienced center, BAS was shown to be safe in patients with severe PAH on maximal medical management, with no procedural deaths or complications. BAS was safely used as a bridge to lung transplantation or to alleviate right heart failure symptoms and/or syncope. Other potential benefits for end-organ function and overall survival remain to be determined.
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York. Electronic address: jsc2175@columbia.edu.
authors: Joanne S
authors: JS
authors: Chiu
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Warren A
authors: WA
authors: Zuckerman
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Mariel E
authors: ME
authors: Turner
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Marc E
authors: ME
authors: Richmond
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Diane
authors: D
authors: Kerstein
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Usha
authors: U
authors: Krishnan
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Alejandro
authors: A
authors: Torres
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Julie A
authors: JA
authors: Vincent
authors: Department of Pediatrics, Division of Cardiology, Columbia University Medical Center, New York, New York.
authors: Erika B
authors: EB
authors: Rosenzweig
mesh_terms: D000293:Adolescent; D000328:Adult; D054087:Atrial Septum / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: balloon atrial septostomy; pulmonary arterial hypertension; right heart failure; survival; syncope