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Atrial Shunting for Heart Failure.
Alexander M Spring1, Andrea Scotti1, Julio Echarte-Morales1
1Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
Structural Heart : the Journal of the Heart Team
|September 2, 2025
Summary
Atrial shunting offers a new treatment for advanced heart failure (HF) patients unresponsive to standard therapies. This review covers the physiology, devices, and trials of atrial shunting across the HF spectrum.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Pharmacological therapies for heart failure (HF) have limitations in managing advanced stages.
- Symptomatic burden in advanced HF remains a significant unmet clinical need.
- Atrial shunting has emerged as a novel therapeutic approach for HF patients.
Purpose of the Study:
- To review the physiology, devices, and clinical trials shaping the field of atrial shunting.
- To explore the application of atrial shunting across the entire spectrum of HF.
- To detail different types of interatrial shunts and their potential clinical benefits and limitations.
Main Methods:
- Review of existing literature on atrial shunting in heart failure.
- Analysis of physiological principles underlying atrial shunt therapies.
- Examination of various device-based and no-implant interatrial shunt strategies.
Main Results:
- Atrial shunting is evolving from a therapy for diastolic HF to one applicable across the HF spectrum.
- Device-based interatrial shunts, no-implant shunts, and coronary sinus shunts are being investigated.
- These shunts aim to provide clinical benefit in specific HF patient populations.
Conclusions:
- Atrial shunting represents a promising novel therapy for symptomatic advanced heart failure.
- Understanding the physiology and device variations is crucial for optimizing patient selection.
- Further trials are needed to fully establish the efficacy and limitations of various atrial shunting techniques.
Keywords:
Atrial shuntingDevice therapyHeart failure with preserved ejection fractionHeart failure with reduced ejection fractionInterventional heart failurePulmonary vasculopathyMore Related Videos
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