Transcatheter atrial shunting in heart failure significantly improved 6MWD (MD 39.29; 95% CI 18.96-59.63) and KCCQ score, but had no significant effect on all-cause mortality (RR 1.27).
Meta-Analysis (n=1,521)
Does transcatheter atrial shunting improve functional, hemodynamic, and clinical outcomes in patients with heart failure?
Transcatheter atrial shunting improves hemodynamics, exercise capacity, and quality of life in heart failure patients, but does not yield significant clinical benefits in mortality or hospitalizations.
Effect estimate: MD 39.29 (95% CI 18.96-59.63)
Abstract Background Despite improvements in heart failure (HF) management, there is still a significant residual risk for adverse events in both trial and real-world settings. Transcatheter atrial shunting is a novel intervention aiming to restore normal hemodynamics and thus improve outcomes. Therefore, the aim of this systematic review and meta-analysis is to evaluate its effect in functional, hemodynamic and clinical outcomes. Methods A systematic search was performed in three databases. Following study selection, a meta-analysis was performed. For continuous outcomes, the mean difference (MD) from baseline along with the 95% confidence interval (95%CI) and for dichotomous outcomes, the risk ratio (RR) and the respective 95%CI, were calculated. Results A total of 12 studies and 1,521 patients were included in the analysis. At a mean follow up of 11.5 months, the six minute walking test distance (6MWD) (MD: 39.29; 95%CI: 18.96; 59.63) and the Kansas City Cardiomyopathy Questionnaire score (MD: 19.71; 95%CI: 12.82; 26.60) significantly increased. Atrial shunting significantly reduced resting (MD: -2.90; 95%CI: -4.10; -1.70) and peak exercise pulmonary capillary wedge pressure (MD: -3.20; 95%CI: -5.14; -1.26), while the mean right atrial pressure significantly increased (MD: 1.33; 95%CI: 0.73; 1.92). No significant effect was found in all-cause mortality (RR: 1.27; 95%CI: 0.82-1.99), major adverse cardiovascular events (RR:1.27; 95%CI: 0.36-4.45) or HF hospitalization (RR:1.27; 95%CI: 0.36-4.45). Conclusions In HF patients, atrial shunting provides significant improvement in exercise capacity, quality of life and hemodynamics. The absence of clinical benefit necessitates further randomized studies focusing on specific phenotypes, in order optimize patient selection and prove clinical effect.
Pyrpyris et al. (Sun,) conducted a meta-analysis in Heart failure (n=1,521). Transcatheter atrial shunting was evaluated on Six minute walking test distance (6MWD) (MD 39.29, 95% CI 18.96-59.63). Transcatheter atrial shunting in heart failure significantly improved 6MWD (MD 39.29; 95% CI 18.96-59.63) and KCCQ score, but had no significant effect on all-cause mortality (RR 1.27).