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Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure : a systematic review and meta‐analysis
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Lauder, Lucas, Pereira, Tiago V., Degenhardt, Markus C., Ewen, Sebastian, Kulenthiran, Saarraaken, Coats, Andrew J. S., Böhm, Michael, Anker, Stefan D., da Costa, Bruno R. and Mahfoud, Felix (2021) Feasibility and efficacy of transcatheter interatrial shunt devices for chronic heart failure : a systematic review and meta‐analysis. European Journal of Heart Failure, 23 (11). pp. 1960-1970. doi:10.1002/ejhf.2360
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WRAP-feasibility-efficacy-transcatheter-interatrial-shunt-devices-chronic-heart-failure-Coats-2021.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (856Kb) | Preview |
Official URL: https://doi.org/10.1002/ejhf.2360
Abstract
Aims: To assess the feasibility and efficacy of interatrial shunt devices (IASD) for the treatment of chronic heart failure (CHF). Methods and results: MEDLINE and the Cochrane Central Register of Controlled Trials from inception until April 2021 were searched for prospective studies investigating dedicated transcatheter IASD for the treatment of CHF. Standardised mean differences were calculated for the within‐group changes before and after implantation of the IASD. The pre‐defined primary outcome was change in 6‐min walking distance (6MWD) from baseline to 12 months. Other outcomes were change in New York Heart Association class, health‐related quality of life (HRQoL), echocardiographic and haemodynamic data, device performance and safety. Subgroup analyses were crude univariable meta‐regression analyses. Six studies (five single‐arm open‐label studies, one sham‐controlled trial) were included. In these, 226 patients underwent IASD implantation using four different devices. From baseline to 12 months, 6MWD increased by 28.1 m [95% confidence interval (CI) 10.9–45.3] with no evidence for a difference between devices (P for interaction = 0.66) and patients with left ventricular ejection fraction (LVEF) >40% or ≤40% (P for interaction = 0.21). At 12 months, HRQoL improved by 17.7 points (95% CI 10.8–24.6) and pulmonary capillary wedge pressure (PCWP) decreased by 2.0 mmHg (95% CI −3.6 to −0.4). There were no changes in LVEF or N‐terminal pro brain natriuretic peptide during follow‐up. Shunt patency ranged from 50% for the first‐generation v‐Wave to 100% for the Corvia IASD II and the second‐generation v‐Wave system, respectively. The summary risk of serious adverse device‐related effects was 8% (95% CI 1–20) at 12 months. Conclusions: Interatrial shunt device implantation in CHF is feasible and associates with improved submaximal exercise capacity (measured by 6MWD) and HRQoL, and reductions in PCWP.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
| SWORD Depositor: | Library Publications Router | ||||||
| Library of Congress Subject Headings (LCSH): | Cardiac catheterization , Heart valves, Heart failure -- Treatment, Arteriovenous shunts, Surgical | ||||||
| Journal or Publication Title: | European Journal of Heart Failure | ||||||
| Publisher: | John Wiley & Sons Ltd. | ||||||
| ISSN: | 1388-9842 | ||||||
| Official Date: | 5 November 2021 | ||||||
| Dates: |
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| Volume: | 23 | ||||||
| Number: | 11 | ||||||
| Page Range: | pp. 1960-1970 | ||||||
| DOI: | 10.1002/ejhf.2360 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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