Left Atrial to Coronary Sinus Shunting for Treatment of Symptomatic Heart Failure

JACC Cardiovasc Interv. 2023 Jun 12;16(11):1369-1380. doi: 10.1016/j.jcin.2023.03.012. Epub 2023 Mar 21.


Background: Heart failure (HF) is associated with both mortality and a significant decline in health status. Interatrial shunting is increasingly being investigated as a novel therapeutic option.

Objectives: The ALT FLOW Early Feasibility Study was designed to evaluate the safety of the Edwards left atrial to coronary sinus APTURE Transcatheter Shunt System in patients with symptomatic HF.

Methods: A total of 18 centers enrolled patients with symptomatic HF with a pulmonary capillary wedge pressure >15 mm Hg at rest or 25 mm Hg during exercise.

Results: Between May 2018 and September 2022, 87 patients underwent attempted APTURE shunt implantation. Mean age was 71 years, and 53% were male. At baseline, mean left ventricular ejection fraction was 59% with 90% of the patients being in NYHA functional class III. Device success was achieved in 78 patients (90%), with no device occlusions or associated adverse events identified after implantation. The primary safety outcome occurred in only 2 patients (2.3%) at 30 days. At 6 months, health status improved: 67% of participants achieved NYHA functional class I to II status, with a 23-point improvement (P < 0.0001; 95% CI: 17-29 points) in the Kansas City Cardiomyopathy Questionnaire overall summary score. Also at 6 months, 20-W exercise pulmonary capillary wedge pressure was 7 mm Hg lower (P < 0.0001; 95% CI: -11 to -4 mm Hg) without change in right atrial pressure or other right heart function indices.

Conclusions: In this single-arm experience, the APTURE Transcatheter Shunt System in patients with symptomatic HF was observed to be safe and resulted in reduction in pulmonary capillary wedge pressure and clinically meaningful improvements in HF symptoms and quality of life indices.

Keywords: HFpEF; HFrEF; atrial shunting; coronary sinus; heart failure; interatrial shunting; left atrial.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrial Fibrillation*
  • Cardiac Catheterization
  • Coronary Sinus* / diagnostic imaging
  • Female
  • Heart Failure* / diagnostic imaging
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Humans
  • Male
  • Quality of Life
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Function, Left