What is the clinical evidence from this study?

Study design: Review. Population: Pulmonary arterial hypertension. Intervention: Interventional and surgical modalities (atrial septostomy, pulmonary endarterectomy, transplantation).

What does this research mean for the field?

Interventional and surgical modalities, including atrial septostomy and pulmonary endarterectomy, are viable therapeutic options that achieve substantial hemodynamic benefit with reduced procedural mortality in appropriately selected pulmonary hypertension patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the efficacy, clinical indications, and procedural outcomes of interventional and surgical modalities in patients with advanced pulmonary arterial hypertension refractory to medical therapy.

September 19, 2026Journal of the American College of CardiologyOpen Access

Interventional and surgical modalities of treatment for pulmonary arterial hypertension

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Key result

Surgical and interventional modalities remain viable for PAH despite procedural mortality rates up to ~10%.

Authors

WKWalter KlepetkoCardiac Surgery EMEckhard MayerCardiac Surgery JSJulio SandovalInstituto Nacional de Cardiología

Discussion

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Implication

Clinical review evaluates interventional and surgical therapies in severe pulmonary arterial hypertension, highlighting their vital role as bridge to transplantation or definitive rescue therapy.

Key Points

To evaluate the efficacy, clinical indications, and procedural outcomes of interventional and surgical modalities in patients with advanced pulmonary arterial hypertension refractory to medical therapy.
Reviewed contemporary procedural techniques including balloon atrial septostomy, Potts shunt creation, pulmonary artery denervation, and mechanical circulatory support.
Assessed surgical outcomes and candidate selection criteria for bilateral lung and combined heart-lung transplantation.
Decompression procedures, such as atrial septostomy and Potts shunt, significantly reduce right ventricular afterload and improve cardiac output in drug-refractory disease.
Pulmonary artery denervation reduces sympathetic overactivity to lower pulmonary vascular resistance, while bilateral lung transplantation offers definitive long-term survival for end-stage cases.

PICO

Population

Pulmonary arterial hypertension

Intervention / Comparator

Interventional and surgical modalities (atrial septostomy, pulmonary endarterectomy, transplantation)

Limitations

Timing of transplantation is difficult due to highly variable and long waiting times between centers.

Cite This Study

Klepetko et al. (2004) conducted a review in Pulmonary arterial hypertension. Interventional and surgical modalities (atrial septostomy, pulmonary endarterectomy, transplantation) was evaluated. Interventional and surgical modalities, such as atrial septostomy (5.4% procedure-related death rate) and pulmonary endarterectomy (<10% perioperative mortality), are viable for PAH.

synapsesocial.com/papers/6aaea733d60a31d9b83eb88e https://doi.org/10.1016/j.jacc.2004.02.039

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Implication

Clinical review evaluates interventional and surgical therapies in severe pulmonary arterial hypertension, highlighting their vital role as bridge to transplantation or definitive rescue therapy.

Interventional and surgical modalities of treatment for pulmonary arterial hypertension

Discussion

Member takes

Implication

Key Points

PICO

Limitations

Cite This Study

Interventional and surgical modalities of treatment for pulmonary arterial hypertension

Discussion

Member takes

Implication

Key Points

PICO

Limitations

Cite This Study

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