Prevalence and outcomes of pulmonary hypertension after percutaneous closure of atrial septal defect: a systematic review and meta-analysis. (16th December 2020)

• Record Type: Journal Article
• Authors: Akseer, Selai; Horlick, Eric; Vishwanath, Varnita; Hobbes, Benjamin; Huszti, Ella; Mak, Susanna; Lee, Douglas S.; Abrahamyan, Lusine
• Is Part Of: European respiratory review. Volume 29:Number 158(2020)
• Publication Date: 2020-12-16
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0099-2020
• Languages: English
• ISSNs: 0905-9180

Abstract

Background: Atrial septal defect (ASD) is a common form of congenital heart disease. Significant shunts may increase the risk of developing pulmonary hypertension (PH). We aimed to describe current PH definitions, evaluate PH prevalence and the effect of PH on outcomes in patients undergoing percutaneous ASD closure. Methods: EMBASE, MEDLINE and Cochrane databases were systematically searched. Studies reporting PH prevalence or mean systolic pulmonary arterial pressure (sPAP) before and after percutaneous ASD closure in adults were included. We conducted meta-analyses to obtain summary estimates for PH prevalence and mean sPAP. Results: 15 articles with a total of 1073 patients met the eligibility criteria. Studies applied variable PH definitions. PH prevalence and mean sPAP levels decreased in all studies after closure. The pooled PH prevalence decreased from 44% (95% CI 29–60%) to 18% (95% CI 8–27%). The overall standardised mean difference in sPAP was 1.12 (95% CI 0.81–1.44) and 1.62 (95% CI 1.00–2.23) in cohort and case-series studies respectively indicating a large decrease. The pooled standard mean difference among the younger and older patients were different, 1.25 (95% CI 0.78–1.71) and 0.91 (95% CI 0.56–1.27), respectively. A high degree of between-study heterogeneity was noted. Conclusions: Both PH prevalence and mean sPAP decrease after ASD closure. Larger, prospective studies with consistent PH definitions using the recommended measurement modality are warranted. We aimed to assess PH in patients with ASD and the effect of percutaneous ASD closure. We found that closure of ASDs can reduce mean systolic pulmonary arterial pressure and PH prevalence. The clinical definition of PH based on cut-off values varied. https://bit.ly/3gjD22o