Combination of F-ASO and Targeted Medical Therapy in Patients With Secundum ASD and Severe PAH.

Chaowu Yan, Xiangbin Pan, Linyuan Wan, Hua Li, Shiguo Li, Huijun Song, Qiong Liu, Fengwen Zhang, Yao Liu, Yong Jiang, Lei Wang, Wei Fang

JACC. Cardiovascular interventions 2020 Sep 14

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This study was conducted to investigate the combined use of fenestrated atrial septal occluder (F-ASO) and targeted medical therapy (TMT) in patients with secundum atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH). Treatment of patients with ASD and severe PAH is still challenging. After ethical approval was obtained, 56 consecutive patients with ASD with severe PAH were included (7 men, 49 women; median age 50.5 years; mean ASD size 26.9 ± 4.6 mm). After 3 months of TMT, transcatheter closure was performed using F-ASO in patients with ratios of pulmonary to systemic blood flow ≥1.5. TMT was continued post-operatively together with 6 months of dual-antiplatelet therapy. The hemodynamic variables during baseline, TMT alone, and combined treatment with F-ASO were compared. After only TMT, systolic pulmonary arterial pressure (-14.5 mm Hg; p < 0.001), pulmonary vascular resistance (-3.9 Wood units; p < 0.001), and exercise capacity (+72.0 m; p < 0.001) improved. Ratio of pulmonary to systemic blood flow increased by 0.9 (p < 0.001), with adverse cardiac remodeling (right ventricular dimension +3.5 mm; p < 0.001). Closure with F-ASO (median size 34.0 mm) led to further decrease in systolic pulmonary artery pressure (-6.0 mm Hg; p < 0.001). Follow-up (median duration 10 months) revealed further improvement in exercise capacity (+60.5 m; p < 0.001), with favorable cardiac remodeling (right ventricular dimension -9.9 mm; p < 0.001). In addition, all fenestrations were stable (p = 0.699), with negligible shunt (median ratio of pulmonary to systemic blood flow 1.1) and no complications. One year later, pulmonary artery pressure was normalized in 8 of 19 patients, and PAH recurred in 5 patients after discontinuation of TMT. In patients with ASD and severe PAH, combination of F-ASO and TMT was a safe and effective procedure. Compared with TMT alone, the combined treatment further improved exercise capacity, with favorable cardiac remodeling. Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Citation

Chaowu Yan, Xiangbin Pan, Linyuan Wan, Hua Li, Shiguo Li, Huijun Song, Qiong Liu, Fengwen Zhang, Yao Liu, Yong Jiang, Lei Wang, Wei Fang. Combination of F-ASO and Targeted Medical Therapy in Patients With Secundum ASD and Severe PAH. JACC. Cardiovascular interventions. 2020 Sep 14;13(17):2024-2034