Efficacy of balloon atrial septostomy for patients with advanced pulmonary arterial hypertension: A meta-analysis

Efficacy of balloon atrial septostomy for patients with advanced pulmonary arterial hypertension: A meta-analysis Dear Editor,Pulmonary arterial hypertension is a serious, progressive lung disease characterised by pulmonary vascular angiopathy, resulting in progressive dyspnoea, exercise limitation and right ventricular (RV) failure leading to premature mortality.1,2 Under healthy conditions, the pulmonary vasculature functions as a low-resistance/ high-flow system.However, in cases of PAH, this balance is disrupted due to the progressive constriction of the small pulmonary arteries.Balloon atrial septostomy in an indicated treatment option for patients with advanced PAH. 3,4 In this study, we conducted a meta-analysis to evaluate the efficacy and safety of balloon atrial septostomy for patients with PAH.Four databases, including Medline, Embase, Cochrane Central and clinicaltrials.govwere searched.All published and indexed trials evaluating the efficacy of balloon atrial septostomy for PAH were included.The reference lists of relevant articles were also manually searched to identify additional articles.The quality assessment of the included studies was done by two independent reviewers and disagreements were resolved through discussion and consensus.The Cochrane risk of bias tool was used for randomized controlled trials (RCTs).The Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) was used to assess non-RCTs.Statistical analyses were performed using STATA 16.0.Mean differences (MD) was used for continuous outcomes and risk ratios (RR) for binary outcomes.The random-effect model was used for continuous outcomes.Fixed-effect model was used for sparse dichotomous outcomes with minimal heterogeneity to obtain more stable pooled estimates.The precision of the effect size was reported with 95% confidence intervals (CIs).A p-value of less than 0.05 was considered as statistically significant.Heterogeneity among studies was assessed using Cochrane's Q test (Chi 2 ) Fund Xiamen Special Program for Supporting the Development of Traditional Chinese Medicine (XWZY-2025-0106).