Innovation in interventional cardiology

Interatrial shunt device

Ici 01 02 Shunt Interauricular

Dr. José R. Rumoroso

30/04/2019

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 Qp/Qs 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

1 . Rodés-Cabau J, Bernier M, Amat-Santos IJ, et al. Interatrial shunting for heart failure: early and late results from the first-in-human experience with the V-Wave system. J Am Coll Cardiol Intv. 2018; 11, 2300-2310. Epub ahead of print.

2 . Sorajja P, Samara M, Eckman P. Atrial shunting for heart failure: where do we need to go? J Am Coll Cardiol Intv. 2018;11,2311-2313. Epub ahead of print.

Keywords: interatrial shunt, heart failure