Device-based treatment options for heart failure with preserved ejection fraction

Miyagi, Chihiro; Miyamoto, Takuma; Karimov, Jamshid H.; Starling, Randall C.

doi:10.1007/s10741-020-10067-5

Cited by 21 publications

(14 citation statements)

References 74 publications

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“…In end-stage HFrEF, systolic function and adequate cardiac hemodynamics can be restored through MCS devices. Although the use of HFrEF MCS devices that support the pumping action of the left ventricle is not recommended in HFpEF, due to reported risks of atrial suction and intraventricular thrombosis ( 86 , 172 , 182 , 185 , 186 , 187 , 188 ), analogous solutions that are specific for HFpEF are currently under development to reduce LAP, enhance LV filling, and restore cardiac output. In this context, a variety of in silico and in vitro studies have been conducted on a number of proposed approaches to investigate their feasibility ( 22 , 175 , 176 , 177 , 178 , 179 ).…”

Section: Discussionmentioning

confidence: 99%

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Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Rosalia

Ozturk

Shoar

et al. 2021

JACC: Basic to Translational Science

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Highlights The prevalence of heart failure with preserved ejection fraction among patients who present with symptoms of heart failure is approximately 50%. Pharmacologic therapy has not conclusively shown benefits in morbidity and mortality in clinical trials. Although it represents an active area of research, no device-based therapy has received regulatory approval for the treatment of heart failure with preserved ejection fraction. Approaches such as atrial shunts, left ventricular expanders, mechanical circulatory support devices, and neurostimulators are at various stages of development.

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Section: Discussionmentioning

confidence: 99%

“…The device is deployed percutaneously using a 16-F sheath via femoral venous access and under fluoroscopic and transesophageal echocardiographic guidance. After transseptal puncture at the mid fossa ovalis, the delivery catheter is positioned in the left atrium and stabilized across the septum ( 86 ).…”

Section: Device-based Solutions For Hfpefmentioning

confidence: 99%

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Rosalia

Ozturk

Shoar

et al. 2021

JACC: Basic to Translational Science

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“…Several reports describe the use of mechanical circulatory support (MCS) systems in the setting of HOCM [ 90 , 91 ], mostly as a bridge-to-transplantation. These treatment strategies include percutaneous interventions with interatrial shunts, left atrial assist devices (LAADs), and ventricular assist devices (VADs) in various configurations [ 90 ], but the data is limited to single-heart transplantation excellence centres [ 92 ].…”

Section: Ecmo and Other Mcsmentioning

confidence: 99%

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

Lebowitz

Kowalewski

Raffa

et al. 2022

JCM

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Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current review were to (1) discuss the place of the standard invasive treatment modalities (ASA and SM) for HOCM; (2) summarize and compare novel techniques for the management of HOCM; (3) analyze current guidelines addressing HOCM management; and (4) offer suggestions for the treatment of complex HOCM presentations. Methods: We searched the literature and attempted to gather the most relevant and impactful available evidence on ASA, SM, and other invasive means of treatment of HOCM. The literature search yielded thousands of results, and 103 significant publications were ultimately included. Results: We critically analyzed available guidelines and provided context in the setting of patient selection for standard and novel treatment modalities. This review offers the most comprehensive analysis to-date of available invasive treatments for HOCM. These include the standard treatments, SM and ASA, as well as novel treatments such as dual-chamber pacing and radiofrequency catheter ablation. We also account for complex pathoanatomic presentations and current guidelines to offer suggestions for tailored care of patients with HOCM. Finally, we consider promising future therapies for HOCM. Conclusions: HOCM is a heterogeneous disease associated with poor outcomes if left untreated. Several strategies for treatment of HOCM are available but patient selection for the procedure is crucial.

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“…While these technologies are at various stages of development, none have received FDA approval. Among technologies under development are a variety of MCS devices that aim to restore adequate CO and LA pressures (LAP; Miyagi et al, 2021c ). These include the Synergy System (HeartWare International), the CoPulse device, and the left atrial assist device (LAAD).…”

Section: Introductionmentioning

confidence: 99%

A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction

2022

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Mechanical circulatory support (MCS) devices are currently under development to improve the physiology and hemodynamics of patients with heart failure with preserved ejection fraction (HFpEF). Most of these devices, however, are designed to provide continuous-flow support. While it has been shown that pulsatile support may overcome some of the complications hindering the clinical translation of these devices for other heart failure phenotypes, the effects that it may have on the HFpEF physiology are still unknown. Here, we present a multi-domain simulation study of a pulsatile pump device with left atrial cannulation for HFpEF that aims to alleviate left atrial pressure, commonly elevated in HFpEF. We leverage lumped-parameter modeling to optimize the design of the pulsatile pump, computational fluid dynamic simulations to characterize hydraulic and hemolytic performance, and finite element modeling on the Living Heart Model to evaluate effects on arterial, left atrial, and left ventricular hemodynamics and biomechanics. The findings reported in this study suggest that pulsatile-flow support can successfully reduce pressures and associated wall stresses in the left heart, while yielding more physiologic arterial hemodynamics compared to continuous-flow support. This work therefore supports further development and evaluation of pulsatile support MCS devices for HFpEF.

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Device-based treatment options for heart failure with preserved ejection fraction

Cited by 21 publications

References 74 publications

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Device-Based Solutions to Improve Cardiac Physiology and Hemodynamics in Heart Failure With Preserved Ejection Fraction

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction

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