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


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.
Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada.
Ignacio J
IJ
Amat-Santos
Sebastien
S
Bergeron
Mathieu
M
Bernier
Ricardo
R
Allende
Henrique
H
Barbosa Ribeiro
Marina
M
Urena
Philippe
P
Pibarot
Stefan
S
Verheye
Gad
G
Keren
Menashe
M
Yaacoby
Yaacov
Y
Nitzan
William T
WT
Abraham
Josep
J
Rodés-Cabau
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation*; D019299:Decompression, Surgical; D006325:Heart Atria / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000601:surgery