Long-Term Outcomes of Endovascular Treatment with Atrial Septal Stent Implantation in Idiopathic Pulmonary Arterial Hypertension

Sergey Gorbachevskiy, Karen Petrosian, Manolis Pursanov, Gulamzhan Dadabaev, Leo Bockeria, Davronbek Pardaev

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–A

Abstract

Background: Idiopathic pulmonary arterial hypertension (IPAH) is characterized by a progressive increase of pulmonary vascular resistance, that ultimately leads to the development of right ventricular failure.

Methods: In our Center stent fenestration of the atrial septum has been performed in 63 patients with iPAH aged from 5 to 56 years. There were 40 (63,5%) females. From 63 patients 41 (65,1%) were in functional class III of modified NYHA classification and 22 (34,9%) – class IV. Stent fenestration of the atrial septum was performed under intubation anesthesia through common femoral venous approach in all cases. The stenting of the interseptal fenestration (ISF) was performed using two techniques: direct stenting (25,4%) with 5-8 mm diameter and 20-30 mm length  peripheral stents and “sand glass” shape stenting (74,6%) with Palmaz-Genesis  stents. Results: In 98,4% of cases interventions and creation of the ISF from 5.0 to 8.0 mm in diameter were successfully performed. Increase of systolic pressure in the pulmonary artery at mean from 105±45 to 125±40 mm hg with a slight decrease of arterial blood oxygen saturation (from 90±2% to 89±2%) was observed in all patients immediately after the intervention. Hospital mortality was 1,6%. Long-term evaluation was performed in 42 patients up to 7 years. One-year survival was 97%, 2-year was 95%, and 7-year was 93%. The walking distance after the procedure was 260 ± 120 meters, that up to 140 m more than before the procedure. 77% of patients were in WHO class I-III (2 in class I, 17 patients – in class II, 13 in class III) but 7 patients were still in class IV.Conclusions: Stent fenestration of the atrial septum combined with specific medical therapy for idiopathic pulmonary arterial hypertension leads to positive changes of the hemodynamics, improvement of clinical status and quality of patient's life.