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Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion

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Abstract

Background

Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect.

Methods and results

From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35–78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6–18) mm; procedure time including diagnostic measures 125 (83–221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93–4401) pg/ml median BNP to 314 (range 61–1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart–lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach.

Conclusions

Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

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References

  1. Towbin JA, Bowles NE (2002) The failing heart. Nature 415:227–233

    Article  PubMed  CAS  Google Scholar 

  2. Gerber Y, Weston SA, Redfield MM, Chamberlain AM, Manemann SM, Jiang R, Killian JM, Roger VL (2015) A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern Med 175:996–1004

    Article  PubMed  PubMed Central  Google Scholar 

  3. Borlaug BA, Redfield MM (2011) Diastolic and systolic heart failure are distinct phenotypes within the heart failure spectrum. Circulation 123:2006–2013

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tschöpe C, Birner C, Böhm M, Bruder O, Frantz S, Luchner A, Maier L, Störk S, Kherad B, Laufs U (2018) Heart failure with preserved ejection fraction: current management and future strategies: Expert opinion on the behalf of the Nucleus of the “Heart Failure Working Group” of the German Society of Cardiology (DKG). Clin Res Cardiol 107(1):1–19

    Article  PubMed  Google Scholar 

  5. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JC, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC European. Heart J 37:27, 14 2129–2200

    Article  Google Scholar 

  6. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumache, Chandrasekaran K, Solomon SD, Louie EK, Schiller MD (2010) NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23:685–713

    Article  PubMed  Google Scholar 

  7. Burns KM, Byrne BJ, Gelb BD, Kühn B, Leinwand LA, Mital S, Pearson GD, Rodefeld M, Rossano JW, Stauffer BL, Taylor MD, Towbin JA, Redington AN (2014) New mechanistic and therapeutic targets for pediatric heart failure: report from a National Heart, Lung, and Blood Institute working group. Circulation 130(1):79–86

    Article  PubMed  PubMed Central  Google Scholar 

  8. Masarone D, Valente F, Rubino M, Vastarella R, Gravino R, Rea A, Russo MG, Pacileo G, Limongelli G (2017) Pediatric heart failure: a practical guide to diagnosis and management. Pediatr Neonatol 58:303–312

    Article  PubMed  Google Scholar 

  9. Masutani S, Little WC, Hasegawa H, Cheng HJ, Cheng CP (2008) Restrictive left ventricular filling pattern does not result from increased left atrial pressure alone. Circulation 117:1550–1554

    Article  PubMed  Google Scholar 

  10. Ouzounian M, Lee DS, Liu PP (2008) Diastolic heart failure: mechanisms and controversies. Nat Clin Pract Cardiovasc Med 5:375–386

    Article  PubMed  Google Scholar 

  11. Masutani S, Saiki H, Kurishima C, Ishido M, Tamura M, Senzaki H (2013) Heart failure with preserved ejection fraction in children. Circ J 77:2375–2382

    Article  PubMed  Google Scholar 

  12. Palazzuoli A, Ruocco G, Beltrami M, Nuti R, Cleland JG (2018) Combined use of lung ultrasound, B-type natriuretic peptide, and echocardiography for outcome prediction in patients with acute HFrEF and HFpEF. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1221-7 [Epub ahead of print]

    Article  PubMed  Google Scholar 

  13. Morbach C, Buck T, Rost C, Peter S, Günther S, Störk S, Prettin C, Erbel R, Ertl G, Angermann CE (2018) Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study. Clin Res Cardiol 107(2):95–107

    Article  PubMed  CAS  Google Scholar 

  14. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37:67–119

    Article  PubMed  Google Scholar 

  15. Ritzema J, Troughton R, Melton I, Crozier I, Doughty R, Krum H, Walton A, Adamson P, Kar S, Shah PK, Richards M, Eigler NL, Whiting JS, Haas GJ, Heywood JT, Frampton CM, Abraham WT, Hemodynamically Guided Home Self-Therapy in Severe Heart Failure Patients Study G (2010) Physician-directed patient self-management of left atrial pressure in advanced chronic heart failure. Circulation 121:1086–1095

    Article  PubMed  Google Scholar 

  16. Bistola V, Simitsis P, Farmakis D, Ikonomidis I, Bakosis G, Triposkiadis F, Hatziagelaki E, Lekakis J, Mebazaa A, Parissis J (2018) Association of mineralocorticoid receptor antagonist use and in-hospital outcomes in patients with acute heart failure. Clin Res Cardiol 107(1):76–86

    Article  PubMed  CAS  Google Scholar 

  17. Ellison DH, Felker GM (2017) Diuretic treatment in heart failure. N Engl J Med 377:1964–1975

    Article  PubMed  CAS  Google Scholar 

  18. Schranz D (2018) Diuretic treatment in heart failure—optimizing or avoiding? N Engl J Med 15(7):683 378)

    Google Scholar 

  19. Del Trigo M, Bergeron S, Bernier M, Amat-Santos IJ, Puri R, Campelo-Parada F, Altisent OA, Regueiro A, Eigler N, Rozenfeld E, Pibarot P, Abraham WT, Rodes-Cabau J (2016) Unidirectional left-to-right interatrial shunting for treatment of patients with heart failure with reduced ejection fraction: a safety and proof-of-principle cohort study. Lancet 387:1290–1297

    Article  PubMed  Google Scholar 

  20. Hasenfuss G, Hayward C, Burkhoff D, Silvestry FE, McKenzie S, Gustafsson F, Malek F, Van der Heyden J, Lang I, Petrie MC, Cleland JG, Leon M, Kaye DM, investigators RL-Hs (2016) A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): a multicentre, open-label, single-arm, phase 1 trial. Lancet 387:1298–1304

    Article  PubMed  Google Scholar 

  21. Kaye DM, Hasenfuss G, Neuzil P, Post MC, Doughty R, Trochu JN, Kolodziej A, Westenfeld R, Penicka M, Rosenberg M, Walton A, Muller D, Walters D, Hausleiter J, Raake P, Petrie MC, Bergmann M, Jondeau G, Feldman T, Veldhuisen DJ, Ponikowski P, Silvestry FE, Burkhoff D, Hayward C (2016) One-year outcomes after transcatheter insertion of an interatrial shunt device for the management of heart failure with preserved ejection fraction. Circ Heart Fail 9:e003662

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hoffmann R, Altiok E, Reith S, Brehmer K, Almalla M (2014) Functional effect of new atrial septal defect after percutaneous mitral valve repair using the MitraClip. Device Am J Cardiol 113:1228e-1233

    Google Scholar 

  23. Guazzi M, Borlaug BA (2012) Pulmonary hypertension due to left heart disease. Circulation 126:975–990

    Article  PubMed  Google Scholar 

  24. Naeije R, Vachiery JL, Yerly P, Vanderpool R (2013) The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease. Eur Respir J 41(1):217–223

    Article  PubMed  Google Scholar 

  25. Schranz D, Bauer A, Reich B, Steinbrenner B, Recla S, Schmidt D, Apitz C, Thul J, Valeske K, Bauer J, Müller M, Jux C, Michel-Behnke I, Akintürk H (2015) Fifteen-year single center experience with the “Giessen Hybrid” approach for hypoplastic left heart and variants: current strategies and outcomes. Pediatr Cardiol 36:365–373

    Article  PubMed  Google Scholar 

  26. Rupp S, Michel-Behnke I, Valeske K, Akintürk H, Schranz D (2007) Implantation of stents to ensure an adequate interatrial communication in patients with hypoplastic left heart syndrome. Cardiol Young 17(5):535–540

    Article  PubMed  Google Scholar 

  27. Schranz B, Akintuerk H, Voelkel NF (2017) ‘End-stage’ heart failure therapy: potential lessons from congenital heart disease: from pulmonary artery banding and interatrial communication to parallel circulation. Heart 103(4):262–267

    Article  PubMed  Google Scholar 

  28. Latus H, Apitz C, Schmidt D, Jux C, Müller M, Bauer J, Akintuerk H, Schneider M, Schranz D (2013) Potts shunt and atrioseptostomy in pulmonary hypertension due to left ventricular disease. Ann Thorac Surg 96:317–319

    Article  PubMed  Google Scholar 

  29. Rupp S, Thul J, Gummel K, Khalil M, Akintuerk H, Schranz D (2017) Surgical-interventional hybrid concert in a newborn with borderline left heart. Ann Thorac Surg 104(1):e71-e73

    Article  PubMed  Google Scholar 

  30. Moysich A, Gunter Kerst G, Hakan Akintürk H, Schranz D (2015) Successful transapical Melody valve implant in mitral bioprothesis in a 3-year old child with dextrocardia and Fontan palliation. JTCVS 150(2):e23–e25

    Google Scholar 

  31. Rosca M, Lancellotti P, Popescu BA, Pierard LA (2011) Left atrial function: pathophysiology, echocardiographic assessment, and clinical applications. Heart 97:1982–1989

    Article  PubMed  Google Scholar 

  32. Abbate A, Arena R, Abouzaki N, Van Tassell BW, Canada J, Shah K, Biondi-Zoccai G, Voelkel NF (2015) Heart failure with preserved ejection fraction: refocusing on diastole. Int J Cardiol 179:430–40

    Article  PubMed  Google Scholar 

  33. Richartz BM1, Werner GS, Ferrari M, Figulla HR (2002) Comparison of left ventricular systolic and diastolic function in patients with idiopathic dilated cardiomyopathy and mild heart failure versus those with severe heart failure. Am J Cardiol 90(4):390–394

    Article  PubMed  Google Scholar 

  34. Tan YT, Wenzelburger F, Lee E et al (2009) The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion. J Am Coll Cardiol 54:36–46

    Article  PubMed  Google Scholar 

  35. Feldman T, Mauri L, Kahwash R, Litwin S, Ricciardi MJ, van der Harst P, Penicka M, Fail PS, Kaye DM, Petrie MC, Basuray A, Hummel SL, Forde-McLean R, Nielsen CD, Lilly S, Massaro JM, Burkhoff D, Shah SJ, for the REDUCE LAP-HF I Investigators (2018) A transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I): a phase 2, randomized, sham-controlled trial. Circulation 137(4):364–375

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hessen Pediatric Heart Center, Justus Liebig University Clinic Giessen, Giessen, Germany

    Anna Bauer, Markus Khalil, Monika Lüdemann, Jürgen Bauer, Hakan Akintuerk & Dietmar Schranz

  2. Hessen Pediatric Heart Center, Johann-Wolfgang Goethe University Hospital Frankfurt, Theodor-Storm-Kai. 7, 60590, Frankfurt, Germany

    Anoosh Esmaeili & Dietmar Schranz

  3. Cardiovascular Department, University of Salerno, Fisciano, Italy

    Roberta De-Rosa

  4. Free University Medical Center (VUMC) Amsterdam, Amsterdam, The Netherlands

    Norbert F. Voelkel

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  1. Anna Bauer
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Correspondence to Dietmar Schranz.

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Bauer, A., Khalil, M., Lüdemann, M. et al. Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion. Clin Res Cardiol 107, 845–857 (2018). https://doi.org/10.1007/s00392-018-1255-x

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  • DOI: https://doi.org/10.1007/s00392-018-1255-x

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