Interatrial Shunt Devices in Management of Heart Failure: A Systematic Review and Meta-Analysis

Background Recent studies have shown that interatrial shunt devices (ISDs) can improve cardiac function and exercise tolerance in people with heart failure (HF). In this systematic review and meta-analysis, we assessed the efficacy of ISDs in the treatment of HF. Methods The Medline, Cochrane Library, Embase, and PubMed databases were searched through to December 7, 2022, to identify clinical studies that evaluated the effect of ISDs on HF. The primary endpoint was change in left ventricular ejection fraction (LVEF). Secondary endpoints included left atrial volume index, left ventricular end-diastolic diameter, right ventricular diameter, and tricuspid annular plane systolic excursion. Clinical functional capacity, including the 6-minute walk distance, New York Heart Association functional class, and N-terminal pro-B-type natriuretic peptide level, were also evaluated. Results Six trials that included 182 individuals were included in the quantitative analysis. Pooled analyses showed that LVEF increased by a mean of 3.07% (95% confidence interval [CI] 0.30, 5.84; P = 0.03) after ISDs implantation. There was no significant change in left atrial volume index (mean difference [MD] -0.33 mL/m², 95% CI -4.80, 4.13; P = 0.88; I 2 = 0), left ventricular end-diastolic diameter (MD -0.53 cm, 95% CI -1.58, 0.53; P = 0.33; I 2 = 80%), right ventricular diameter (MD 1.40 mm, 95% CI -1.72, 4.51; P = 0.38; I 2 = 36%), or tricuspid annular plane systolic excursion (MD 0.74 mm, 95% CI -0.49, 1.98; P = 0.24; I 2 = 0) after ISDs implantation. The 6-minute walk distance, N-terminal pro-B-type natriuretic peptide level, and New York Heart Association functional class were improved. Conclusions An ISDs can increase LVEF in patients with HF. Studies in larger sample sizes and with longer follow-up times are needed to confirm our findings.