Novel Therapeutic Devices in Heart Failure

Abstract

Heart failure (HF) constitutes a significant clinical problem and is associated with a sizeable burden for the healthcare system. Numerous novel techniques, including device interventions, are investigated to improve clinical outcome. A review of the most notable currently studied devices targeting pathophysiological processes in HF was performed. Interventions regarding autonomic nervous system imbalance, i.e., baroreflex activation therapy; vagus, splanchnic and cardiopulmonary nerves modulation; respiratory disturbances, i.e., phrenic nerve stimulation and synchronized diaphragmatic therapy; decongestion management, i.e., the Reprieve system, transcatheter renal venous decongestion system, Doraya, preCardia, WhiteSwell and Aquapass, are presented. Each segment is divided into subsections: potential pathophysiological target, existing evidence and weaknesses or unexplained issues. Novel therapeutic devices represent great potential in HF therapy management; however, further evidence is necessary to fully evaluate their utility.

Modern Approaches for the Treatment of Heart Failure: Recent Advances and Future Perspectives

“…According to Costanzo et al, patients who received phrenic nerve stimulation displayed an increase in the QOL and LVEF without a substantial change in end-systolic and enddiastolic volumes [141]. Large-scale clinical studies are necessary to determine the impact of phrenic nerve stimulation on mortality in individuals with HF and CSA syndrome [145].…”

“…Increased intrathoracic pressure exerts persistent stress on the heart muscle and may exacerbate heart failure (HF). The respiratory muscles have a substantial effect on intrathoracic pressure, and, thus, the implantation of a device coupled to an electrode that detects the heartbeat that activates the diaphragm was developed [145]. In the Stimulation of the Diaphragm in Patients with Severe Heart Failure Following Heart Surgery randomized trial including 33 subjects, an improvement in LVEF and HF symptoms, and an elevation in maximal power and oxygen consumption during exercise testing was noticed, with no considerable improvement in the six MWT, nor the BNP levels [146].…”

“…Although loop diuretics continue to represent the backbone of decongestive treatment in HF, the occurrence of drug resistance, particularly with prolonged usage, poses a therapeutic issue that requires the development of novel approaches [145].…”

“…The first human trials of the Doraya catheter, a device designed to transiently lower renal venous pressure by generating a manageable gradient in the inferior vena cava just under the renal veins, have shown encouraging results [149]. The Doraya catheter appears to represent an innovative idea for the management of AHF patients with poor diuretic response, whereas the Reprieve device is intended for AHF patients responsive to diuretics [145].…”

GSTM2 alleviates heart failure by inhibiting DNA damage in cardiomyocytes

“…From an anatomical view, heart tissue includes four cavities, four valves, large arteries, and veins, and heart tissue is primarily composed of cardiac fibroblasts (CFs), cardiomyocytes, smooth muscle cells (SMCs), and endothelial cells (ECs) [ 5 , 6 ]. During the progression of HF, the expression profiles of genes and proteins in different cardiac regions change in different ways [ 7 – 9 ].…”