Interatrial Shunting, a Novel Device-Based Therapy for Patients With Heart Failure.

ABSTRACT

Heart failure (HF) patients with either reduced ejection fraction or preserved ejection fraction experience a high mortality rate. The most recent pharmacologic advance for treating patients with HF with reduced ejection fraction has been with sacubitril/valsartan. Along with pharmaceutical research, there has been interest in device-based therapies as another treatment approach. One novel interventional device therapy that has shown promise in early tests and trials is the interatrial shunt device developed by Corvia Medical Inc. and the V-Wave device by V-Wave Ltd. Inserted between the atria in the atrial septum, both devices create a left-to-right unidirectional shunt. The aim is to decompress the left atrium, thereby, possibly reducing symptoms related to pulmonary congestion. With encouraging initial results and a favorable safety profile in non-randomized studies involving less than 100 patients, interatrial shunting may be a viable therapeutic approach for HF patients who remain symptomatic despite optimal medical therapy. It is hoped that these devices will be especially effective in HF with preserved ejection fraction, which has seen very few successful treatments in the past decade. To solidify its place as a successful treatment option, however, the results from randomized controlled trials, which are currently underway, will be crucial.