Transcatheter Interatrial Shunts for the Treatment of Heart Failure with Preserved Ejection Fraction

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remodeling and dysfunction is central to HFpEF and accounts for secondary pulmonary hypertension and pulmonary vascular congestion that frequently occurs with exertion. Interatrial shunts represent a novel treatment modality for HFpEF. These shunts allow for left atrial decongestion and a reduction in pulmonary venous hypertension during exercise leading to improvements in hemodynamics, functional status and quality of life. Trials to date have demonstrated safety and short-term efficacy of these devices for HFpEF. The long-term benefits are currently being evaluated in ongoing trials. If effective, the use of interatrial shunts may be a new therapeutic paradigm for the treatment of HFpEF.

Feasibility of a No-Implant Approach to Interatrial Shunts: Preclinical and Early Clinical Studies

“… 22 , 23 Although patency is expected with implantable shunts, there have been instances of device occlusion, rendering it a treatment with variable outcomes. 18 , 20 Delivering the potential therapeutic benefits of an IAS without a permanent cardiac implant may have clinical and procedural advantages. These include avoidance of device embolization, tissue erosion, device-associated thrombus formation, procedure-related device placement complications, the need for long-term DAPT, and preservation of native septal tissue for future transseptal access.…”

“…Interatrial shunt (IAS) devices to treat HFpEF and heart failure with reduced ejection fraction are in various stages of design and clinical trials. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 These devices leverage the principle of left atrial decompression via delivery of interatrial stents, or radiofrequency(RF)-ablative septostomy, to reduce left atrial filling pressures and relieve pulmonary vascular congestion. These therapies are being studied for their potential to reduce heart failure symptoms, improve quality of life, and reduce heart failure hospitalizations.…”