Interatrial shunt devices for heart failure with normal ejection fraction: a technology update

Cuthbert, Joe; Pellicori, Pierpaolo; Clark, Andrew L.

doi:10.2147/mder.s113105

Cited by 2 publications

(3 citation statements)

References 67 publications

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“…Interatrial shunts 13,14,23,24 Interatrial shunt device Corvia Medical; The Synergy System CircuLite pump is in a left atrial to right axillary artery configuration. Outflow to the right axillary is functionally the same as outflow to the aorta and as such can be used interchangeably here.…”

Section: Devices Manufacturersmentioning

confidence: 99%

“…This allows for left-to-right shunting and unloading of the left atrium, which has shown to lead to reductions in pulmonary capillary wedge pressure (PCWP) and improved hemodynamics. 13,14 In a 2014 pilot study of patients with HFpEF, IASDs decreased leftsided filling pressure and demonstrated improvements in NYHA functional class, quality of life, and six-minute walk distance. 15 However, such a shunt would not necessarily improve overall cardiac output, as there is no contribution to forward flow and LV dynamics are not directly impacted.…”

Section: Percutaneous Interventions For Rcm and Hcmmentioning

confidence: 99%

“…One such device, the Interatrial shunt device (IASD) (Corvia Medical; Tewksbury, MA), is inserted by trans‐septal catheterization and is situated in the interatrial septum, maintaining a connection between the atria (Figure 1). This allows for left‐to‐right shunting and unloading of the left atrium, which has shown to lead to reductions in pulmonary capillary wedge pressure (PCWP) and improved hemodynamics 13,14 . In a 2014 pilot study of patients with HFpEF, IASDs decreased left‐sided filling pressure and demonstrated improvements in NYHA functional class, quality of life, and six‐minute walk distance 15 .…”

Section: Percutaneous Interventions For Rcm and Hcmmentioning

confidence: 99%

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Mechanical and interventional support for heart failure with preserved ejection fraction: A review

et al. 2022

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Introduction Restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) are two disease processes that are known to progress to heart failure with preserved ejection fraction (HFpEF). Pharmacologic therapies for HFpEF have not improved patient outcomes or reduced mortality in this patient cohort; thus, there continues to be substantial interest in other treatment strategies, including surgical interventions and devices. In this article, we explore and report the current utility of percutaneous therapies and surgically implanted mechanical support in the treatment of patients with HFpEF. Results Treatment strategies include percutaneous interventions with interatrial shunts, left atrial assist devices (LAADs), and ventricular assist devices (VADs) in various configurations. Although VADs have been employed to treat patients with heart failure with reduced ejection fraction, their efficacy is limited in those with RCM and HCM. A left atrial‐to‐aortic VAD has been proposed to directly unload the left atrium, but data is limited. Alternatively, a LAAD could be placed in the mitral position and simultaneously unload the left atrium, while filling the left ventricle. Conclusion A left atrial assist device in the mitral position is a promising solution to address the hemodynamic abnormalities in RCM and HCM; these pumps, however, are still under development.

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Section: Devices Manufacturersmentioning

confidence: 99%

Section: Percutaneous Interventions For Rcm and Hcmmentioning

confidence: 99%

Section: Percutaneous Interventions For Rcm and Hcmmentioning

confidence: 99%

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Mechanical and interventional support for heart failure with preserved ejection fraction: A review

et al. 2022

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Short-term study of atrial shunt and improvement of functional mitral regurgitation

Shang,

Liu,

Zhong

et al. 2023

J Cardiothorac Surg

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Background This study used an atrial septal shunt to compare the treatment progress and prognosis for patients with heart failure (HF) who have different ejection fractions. Methods Twenty HF patients with pulmonary hypertension, who required atrial septal shunt therapy, were included in this study. The patients underwent surgery between December 2012 and December 2020. They were divided into two groups based on their ejection fraction: a group with reduced ejection fraction (HFrEF) and a group with preserved ejection fraction(HFpEF) + mid-range ejection fraction (HfmrEF). Echocardiography was utilized to evaluate parameters such as left ventricular dimension (LVD), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume (LVEDV). Hemodynamic parameters were measured using cardiac catheterization. The patient's cardiac function was assessed using the six-minute walking test (6MWT), KCCQ score, NYHA classification, and the degree of functional mitral regurgitation (FMR). Followed-up visits were conducted at 1, 3, and 6 months, and any adverse effects were recorded. Results The LVEF values were consistently higher in the HFpEF+HFmrEF group than HFrEF group at all periods (P < 0.05). Differences in LVD were observed between the two groups before the surgery. Statistically, significant differences were found at the preoperative stage, 1 month, and 3 months (P < 0.05, respectively). However, the LVEDV showed a significant difference between the two groups only at 3 months (P = 0.049). Notably, there were notable variations in LAPm, LAPs, and the pressure gradient between the LA-RA gradient at baeline, after implantation, and during the 6 months follow-up (all P < 0.05). Conclusion Following treatment, the HFpEF+HFmrEF group exhibited more significant improvements in echocardiographic and cardiac catheterization indices than the HFrEF group. However, there was no statistically significant difference between the two groups regarding the 6MWT and KCCQ scores. It is important to note that the findings of this study still require further investigation in a large sample size of patients.

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Interatrial shunt devices for heart failure with normal ejection fraction: a technology update

Cited by 2 publications

References 67 publications

Mechanical and interventional support for heart failure with preserved ejection fraction: A review

Mechanical and interventional support for heart failure with preserved ejection fraction: A review

Short-term study of atrial shunt and improvement of functional mitral regurgitation

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