Innovation in interventional cardiology

Recently, data were published on a device for the treatment of New York Heart Association (NYHA) class III-IV/IV heart failure in patients with impaired or preserved ventricular function1,2.

The medical treatment of heart failure can be complemented with cardiac resynchronization devices, ventricular assistance, and transplantation. It is now possible to add a new device: a one-way, hourglass-shaped bioprosthesis that is implanted in the interatrial septum via transseptal puncture. The aim of this treatment is to create a left-to-right shunt in patients with a high left atrial pressure or very restrictive left atrium. This decongestion reduces the pulmonary capillary pressure at rest and during exercise, with a small reduction in cardiac output. The created shunt is small, with a Q_p/Q_s of approximately 1.27. The volume overload on the right ventricle is low, so the probability of causing pulmonary hypertension is low.

The risk of complications from the procedure is very low: there is a risk of cardiac tamponade, essentially due to the transseptal access (2.6%). However, the improvement in functional class and exercise capacity is significant, as is the reduction in hospitalization, transplantation, ventricular assistance and pulmonary capillary pressure. Nonetheless, some complications have been reported at 12 months’ follow-up, including valve closure in 14% of patients and valve stenosis in 36%.

The technological innovation in this field is promising for the improvement of symptoms in patients with heart failure; in the coming years we will see advances to avoid stenosis in these devices with new randomized trials.

References

Keywords: interatrial shunt, heart failure