Interatrial shunting for the treatment of heart failure: an <scp>on‐demand</scp>, <scp>self‐regulating</scp> left atrial pressure lowering system

Abraham, William T.

doi:10.1002/ejhf.2184

Cited by 4 publications

(8 citation statements)

References 10 publications

(16 reference statements)

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“…In the DAPA‐HF trial, treatment with dapagliflozin increased the KCCQ total symptom score at 8 months by 7.0 points in diabetics and by 5.4 points in non‐diabetics 44 . Similarly large improvements were only reported for transvenous edge‐to‐edge mitral valve repair of secondary mitral regurgitation where KCQQ score improved by 12.5 points 6,45 . One may speculate that the invasiveness of the procedure and lack of a sham control contributed to the relatively large effects on HRQoL seen in the device‐based trials.…”

Section: Discussionmentioning

confidence: 99%

“…44 Similarly large improvements were only reported for transvenous edge-to-edge mitral valve repair of secondary mitral regurgitation where KCQQ score improved by 12.5 points. 6,45 One may speculate that the invasiveness of the procedure and lack of a sham control contributed to the relatively large effects on HRQoL seen in the device-based trials.…”

Section: Discussionmentioning

confidence: 99%

“…Individual adjustments of HF therapy, particularly diuretics, guided by invasive pulmonary artery pressures using an implantable pressure sensor can reduce HF‐related hospitalisations 5 . However, pressure‐guided CHF therapy requires patient's adherence, is rather complex and cost‐intensive 6 . Moreover, pharmacological therapies can barely countervail rapid volume shifts from the capacitance vessels into the arterial circulation 6,7 …”

Section: Introductionmentioning

confidence: 99%

“…5 However, pressure-guided CHF therapy requires patient's adherence, is rather complex and cost-intensive. 6 Moreover, pharmacological therapies can barely countervail rapid volume shifts from the capacitance vessels into the arterial circulation. 6,7 In analogy to patients with mitral stenosis, where a concomitant small congenital atrial septal defect (Lutembacher's syndrome) associates with fewer symptoms and better outcomes compared with isolated mitral stenosis, 8 various left-to-right interatrial shunt devices (IASD) are currently under investigation for left atrial decompression in patients with CHF.…”

Section: Introductionmentioning

confidence: 99%

“…6 Moreover, pharmacological therapies can barely countervail rapid volume shifts from the capacitance vessels into the arterial circulation. 6,7 In analogy to patients with mitral stenosis, where a concomitant small congenital atrial septal defect (Lutembacher's syndrome) associates with fewer symptoms and better outcomes compared with isolated mitral stenosis, 8 various left-to-right interatrial shunt devices (IASD) are currently under investigation for left atrial decompression in patients with CHF. 9 This systematic review and meta-analysis assessed the feasibility of dedicated catheter-based IASD and their impact on the symptomatology and function in patients with both HFpEF and HFrEF.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure: a systematic review and meta‐analysis

Lauder

Pereira

Degenhardt

et al. 2021

European J of Heart Fail

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AimsTo assess the feasibility and efficacy of interatrial shunt devices (IASD) for the treatment of chronic heart failure (CHF). Methods and resultsMEDLINE and the Cochrane Central Register of Controlled Trials from inception until April 2021 were searched for prospective studies investigating dedicated transcatheter IASD for the treatment of CHF. Standardised mean differences were calculated for the within‐group changes before and after implantation of the IASD. The pre‐defined primary outcome was change in 6‐min walking distance (6MWD) from baseline to 12 months. Other outcomes were change in New York Heart Association class, health‐related quality of life (HRQoL), echocardiographic and haemodynamic data, device performance and safety. Subgroup analyses were crude univariable meta‐regression analyses. Six studies (five single‐arm open‐label studies, one sham‐controlled trial) were included. In these, 226 patients underwent IASD implantation using four different devices. From baseline to 12 months, 6MWD increased by 28.1 m [95% confidence interval (CI) 10.9–45.3] with no evidence for a difference between devices (P for interaction = 0.66) and patients with left ventricular ejection fraction (LVEF) >40% or ≤40% (P for interaction = 0.21). At 12 months, HRQoL improved by 17.7 points (95% CI 10.8–24.6) and pulmonary capillary wedge pressure (PCWP) decreased by 2.0 mmHg (95% CI −3.6 to −0.4). There were no changes in LVEF or N‐terminal pro brain natriuretic peptide during follow‐up. Shunt patency ranged from 50% for the first‐generation v‐Wave to 100% for the Corvia IASD II and the second‐generation v‐Wave system, respectively. The summary risk of serious adverse device‐related effects was 8% (95% CI 1–20) at 12 months. ConclusionsInteratrial shunt device implantation in CHF is feasible and associates with improved submaximal exercise capacity (measured by 6MWD) and HRQoL, and reductions in PCWP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure: a systematic review and meta‐analysis

Lauder

Pereira

Degenhardt

et al. 2021

European J of Heart Fail

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Heart failure: an update from the last years and a look at the near future

et al. 2022

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In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.

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Device-based percutaneous treatments to decompress the left atrium in heart failure with preserved ejection fraction

et al. 2022

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Heart failure with preserved ejection fraction (HFpEF) accounts for more than half of heart failure hospital admissions in the last years and is burdened by high mortality and poor quality of life. Providing effective management for HFpEF patients is a major unmet clinical need. Increase in left atrial pressure is the key determinant of pulmonary congestion, with consequent dyspnoea and exercise limitation. Evidence on benefits of medical treatment in HFpEF patients is limited. Thus, alternative strategies, including devices able to reduce left atrial pressure, through an interatrial communication determining a left–right shunt, were developed. This review aims to summarize evidence regarding the use of percutaneous interatrial shunting devices. These devices are safe and effective in improving hemodynamic and clinical parameters, including pulmonary capillary wedge pressure, 6-min walking distance, and New York Heart Association functional class. Data on cardiovascular mortality and re-hospitalization for heart failure are still scarce.

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Interatrial shunting for the treatment of heart failure: an on‐demand, self‐regulating left atrial pressure lowering system

Cited by 4 publications

References 10 publications

Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure: a systematic review and meta‐analysis

Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure: a systematic review and meta‐analysis

Heart failure: an update from the last years and a look at the near future

Device-based percutaneous treatments to decompress the left atrium in heart failure with preserved ejection fraction

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