Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure : first-inman experience with the V-Wave device

Authors: Amat Santos, Ignacio J.Bergeron, SébastienBernier, MathieuAllende, RicardoBarbosa Ribeiro, HenriqueUrena Alcazar, MarinaPibarot, Philippe; Verheye, Stefan; Keren, Gad; Yaacoby, Menashe; Nitzan, Yaacov; Abraham, William T.; Rodés-Cabau, Josep
Abstract: Aims: Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience with the V-Wave device. Methods and results: A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance. The device was successfully implanted and the patient was discharged 24 hours after the procedure with no complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from 39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function. Conclusions: Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days.
Document Type: Article de recherche
Issue Date: 1 January 2015
Open Access Date: 26 September 2016
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/6910
This document was published in: EuroIntervention, Vol. 10 (9) 1127-31 (2015)
http://dx.doi.org/10.4244/EIJY14M05_07
Europa Ed.
Alternative version: 10.4244/EIJY14M05_07
24832489
Collection:Articles publiés dans des revues avec comité de lecture

Files in this item:
SizeFormat 
Amat-Santos2014-14299.pdf934.92 kBAdobe PDFView/Open
All documents in CorpusUL are protected by Copyright Act of Canada.