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Butera G, Piccinelli E, Kolesnik A, Averin K, Seaman C, Castaldi B, Cuppini E, Fraisse A, Bautista-Rodriguez C, Hascoet S, D'Amore C, Baruteau AE, Blasco PB, Bianco L, Eicken A, Jones M, Kuo JA, Rajszys GB. Implantation of atrial flow regulator devices in patients with congenital heart disease and children with severe pulmonary hypertension or cardiomyopathy-an international multicenter case series. Front Cardiovasc Med 2024; 10:1332395. [PMID: 38288053 PMCID: PMC10822980 DOI: 10.3389/fcvm.2023.1332395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024] Open
Abstract
Background The Occlutech Atrial Flow Regulator (AFR) is a self-expandable double-disc nitinol device with a central fenestration. Its use has been approved in the adult population with heart failure and described for pulmonary hypertension (PH). Only case reports and small series have been published about its use in the paediatric population and for congenital heart disease (CHD). Objectives The authors sought to investigate the feasibility, safety, and short-term follow-up of AFR implantation in patients with CHD or children with PH or cardiomyopathy. Methods This is a multicenter retrospective study involving 10 centers worldwide. Patients of any age with CHD or patients aged < 18 years with PH or cardiomyopathy needing AFR implantation were included. Results A total of 40 patients underwent AFR implantation. The median age of the population at the time of the procedure was 58.5 months (IQR: 31.5-142.5) and the median weight was 17 kg (IQR: 10-46). A total of 26 (65.0%) patients had CHD, nine (22.5%) children, a cardiomyopathy, and five (12.5%), a structurally normal heart. The implantation success rate was 100%. There were two early and one late device thrombosis. Two patients (5.0%) with dilated cardiomyopathy on extracorporeal membrane oxygenator (ECMO) died during the hospital stay. At a median follow-up of 330 days (IQR: 125-593), 37 (92.5%) patients were alive. At follow-up, 20 patients improved their New York Heart Association (NYHA) class, 12 patients did not change their NYHA class, and one patient with idiopathic PH worsened. Conclusions AFR implantation in patients with CHD and children with severe PH or cardiomyopathy is promising and seems to have beneficial effects at short-term follow-up.
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Affiliation(s)
- Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Enrico Piccinelli
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
| | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children’s Memorial Health Institute, Varsavia, Poland
| | - Kostantin Averin
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Cameron Seaman
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada
| | - Biagio Castaldi
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Department, Padova University, Padova, Italy
| | - Alain Fraisse
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | | | - Sebastien Hascoet
- Pediatric Cardiology Department, Royal Brompton Hospital, London, United Kingdom
| | - Carmen D'Amore
- Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PreciCare, Nantes, France
| | - Pedro Betrián Blasco
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Lisa Bianco
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART, Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
- Pediatric Interventional Cardiology Unit, Vall d'Hebron Hospital, Barcellona, Spain
| | - Andreas Eicken
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Matthew Jones
- Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Evelina Children’s Hospital, London, United Kingdom
| | - James A. Kuo
- Division of Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, United States
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Pattathu J, Michel S, Tengler AI, Mandilaras G, Jakob A, Dalla Pozza R, Haas NA. Case report: Beneficial long-term effect of the atrial-flow-regulator device in a pediatric patient with idiopathic pulmonary arterial hypertension and recurring syncope. Front Cardiovasc Med 2023; 10:1197985. [PMID: 37745101 PMCID: PMC10516292 DOI: 10.3389/fcvm.2023.1197985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
We report the long-term effect after successfully implanting an 8 mm Atrial-flow-regulator (AFR) device in a 7-year-old girl with idiopathic pulmonary hypertension with persistent syncope under triple therapy with significant improvement after implantation and absence of any further syncope. Early Implantation of the AFR device (Occlutech, Germany) can be efficient and safe interventional therapy option for pulmonary arterial hypertension with a history of syncope.
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3
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Wood KP, Fleming GA, Chamberlain RC. Update on Transcatheter Device Closure of Congenital Septal Defects. Curr Cardiol Rep 2023; 25:1083-1093. [PMID: 37523002 DOI: 10.1007/s11886-023-01925-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). RECENT FINDINGS Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.
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Affiliation(s)
- Kathleen P Wood
- Division of Pediatric Cardiology, Duke University, Durham, USA
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Michel SG, Hanuna M, Pattathu J, Pabst von Ohain J, Schneider C, Kauke T, Kneidinger N, Behr J, Milger K, Barton J, Veit T, Kamla C, Mueller C, Dzieciol R, Christen L, Irlbeck M, Tomasi R, Abicht J, Scheiermann P, Feuerecker M, Dalla-Pozza R, Fischer M, Jakob A, Hermann M, Haas N, Hagl C, Hörer J. Case report: Paracorporeal lung assist device for 215 days as a bridge-to-lung transplantation in a patient with bronchopulmonary dysplasia and severe pulmonary hypertension. FRONTIERS IN TRANSPLANTATION 2023; 2:1197906. [PMID: 38993847 PMCID: PMC11235335 DOI: 10.3389/frtra.2023.1197906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2024]
Abstract
Pulmonary hypertension (PH) is a known and life limiting complication of preterm born young adults with bronchopulmonary dysplasia (BPD), ultimately leading to progressive right ventricular (RV) failure. Prognosis remains poor, especially in patients unresponsive to modern vasoactive pharmacotherapy. Therefore, lung transplantation presents the treatment of choice to avert cardiac failure. With limited donor organ availability and long waiting times, the implantation of a paracorporeal lung assist device (PLAD) is a way to bridge the patient as an alternative to veno-arterial ECMO. Herein, we present the case of a prematurely born 23-year-old female, who developed severe PH due to BPD and consequently experienced therapy refractory RV failure. Urgent PLAD implantation was performed and the patient successfully underwent double-lung transplantation after 215 days of PLAD support. No major PLAD-associated complications occurred and full recovery of RV function could be observed after double-lung transplantation.
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Affiliation(s)
- Sebastian G. Michel
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Maja Hanuna
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Joseph Pattathu
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Jelena Pabst von Ohain
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Christian Schneider
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Thoracic Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Theresa Kauke
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Thoracic Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine V, Pulmonology, Ludwig Maximilian University Munich, Munich, Germany
| | - Juergen Behr
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine V, Pulmonology, Ludwig Maximilian University Munich, Munich, Germany
| | - Katrin Milger
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine V, Pulmonology, Ludwig Maximilian University Munich, Munich, Germany
| | - Juergen Barton
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine V, Pulmonology, Ludwig Maximilian University Munich, Munich, Germany
| | - Tobias Veit
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Medicine V, Pulmonology, Ludwig Maximilian University Munich, Munich, Germany
| | - Christine Kamla
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph Mueller
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Robert Dzieciol
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Lauren Christen
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Roland Tomasi
- Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Jan Abicht
- Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Patrick Scheiermann
- Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Matthias Feuerecker
- Department of Anesthesiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Robert Dalla-Pozza
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Matthias Hermann
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Nikolaus Haas
- Department of Pediatric Cardiology and Intensive Care, Ludwig Maximilian University Munich, Munich, Germany
| | - Christian Hagl
- Comprehensive Pneumology Center Munich, German Center for Lung Research (DZL), Munich, Germany
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Jürgen Hörer
- Division of Congenital and Pediatric Heart Surgery, Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Kanwar MK, Everett KD, Gulati G, Brener MI, Kapur NK. Epidemiology and management of right ventricular-predominant heart failure and shock in the cardiac intensive care unit. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:584-594. [PMID: 35767583 DOI: 10.1093/ehjacc/zuac063] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
Cardiogenic shock from left ventricular failure is a common presentation in the intensive care unit. In contrast, right ventricular (RV)-predominant heart failure (HF) causing shock is less well recognized. We review the epidemiology and mechanisms of RV-predominant HF and discuss pharmacologic and device-based approaches for the management of this challenging clinical problem.
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Affiliation(s)
- Manreet K Kanwar
- Department of Medicine, Cardiovascular Institute at Allegheny Health Network, Pittsburgh, PA, USA
| | - Kay D Everett
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
| | - Gaurav Gulati
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
| | - Michael I Brener
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Navin K Kapur
- Department of Medicine, The CardioVascular Center, Tufts Medical Center, 800 Washington Street, Box # 80, Boston, MA 02111, USA
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Shang X, Liu M, Zhong Y, Wang X, Chen S, Fu X, Sun M, Xie M, Ke Y, Guan Y, Zhang C, Dong N. Clinical study on the treatment of chronic heart failure with a novel D-shant atrium shunt device. ESC Heart Fail 2022; 9:1713-1720. [PMID: 35179320 PMCID: PMC9065846 DOI: 10.1002/ehf2.13842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Atrial septal shunt devices might improve hospitalizations and also prognosis in heart failure with increased pulmonary pressures due to left heart diseases. In recent years, atrial shunt devices have been used for the treatment of chronic heart failure, but there remains a lack of clinical experience. This study aimed to analyse the therapeutic effect of a novel type of atrial shunt on chronic heart failure. METHODS AND RESULTS From May 2020 to September 2020, six patients who were diagnosed with chronic heart failure and completed percutaneous D-shant atrium shunt device implantation in the Department of Cardiovascular Surgery, Union Hospital, were retrospectively included. The shunt location was evaluated by echocardiography and digital subtraction angiography. Heart function was evaluated by New York Heart Association functional class. Echocardiography was used to measure the diameter of the new chamber and ventricle, and to evaluate the degree of mitral and tricuspid regurgitation. Before operation and 6 months after operation, left atrial end-diastolic volume, right atrial end-diastolic volume, left ventricular end-diastolic volume, and right ventricular end-diastolic volume were measured by magnetic resonance imaging. Left ventricular ejection fractions and right ventricular ejection fractions were calculated. Haemodynamic indexes of right heart catheterization and clinical cardiac function indexes were collected and compared before and 6 months after shunt implantation. All six patients completed percutaneous shunt device implantation. Echocardiography and digital subtraction angiography showed that the shunt device was correctly positioned and unobstructed in all patients. Echocardiography revealed that the left ventricular diameter decreased significantly from 6.40 ± 0.57 mm to 5.03 ± 0.73 mm (P < 0.05). There was an obvious decrease in mitral regurgitation. Magnetic resonance imaging showed a reduction in the volume of the left ventricle (182.00 ± 27.02 mL vs. 125.75 ± 16.11 mL, P < 0.05). Cardiac catheter examination showed the mean left atrium pressure or pulmonary capillary wedge pressure decreased postoperatively (31.83 ± 11.55 vs. 18.00 ± 5.51 mmHg, P < 0.05). There was also obvious improvement in clinical indicators of cardiac function at 6 months after implantation. CONCLUSIONS This novel D-shant atrium shunt device revealed maintained good function, no dislodgement and no paradoxical emboli. After implantation, functional mitral regurgitation in all patients with heart failure with reduced ejection fraction improved.
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Affiliation(s)
- Xiaoke Shang
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Mei Liu
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
- Department of Hospital Infection OfficeWuhan No. 1 HospitalWuhanChina
| | - Yucheng Zhong
- Department of Cardiovascular Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xueli Wang
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Song Chen
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Xiaojuan Fu
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Ming Sun
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yuhe Ke
- Department of Hospital Infection OfficeWuhan No. 1 HospitalWuhanChina
| | - Ying Guan
- Department of Hospital Infection OfficeWuhan No. 1 HospitalWuhanChina
| | - Changdong Zhang
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
| | - Nianguo Dong
- Cardiac Laboratory, Department of Cardiovascular Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and Technology1277 Jiefang Avenue, Jianghan DistrictWuhanHubei Province430022China
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Yang L, Zhang L, Chen S, Li M, Long Y, Li W, Jin Q, Guan L, Zhou D, Ge J. Efficacy of interatrial shunt devices: an opening window to acute pulmonary hypertensive crisis and chronic pulmonary arterial hypertension. J Thromb Thrombolysis 2022; 54:123-131. [DOI: 10.1007/s11239-022-02635-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/30/2022]
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Babur Guler G, Dogan AC, Kalkan AK, Demir AR, Uygur B, Birant A, Zencirkiran Agus H, Pastore MC, Memiç K, Uzun F, Cameli M, Erturk M. Does patent foramen ovale presence procure favourable outcomes in patients with severe rheumatic mitral stenosis? Int J Cardiovasc Imaging 2021; 37:2871-2879. [PMID: 34109513 DOI: 10.1007/s10554-021-02257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
Mitral stenosis (MS) is tolerated for an extended period in patients with atrial septal defect (ASD) known as Lutembacher syndrome due to depressurizing effect. In a similar way, patients with patent foramen ovale (PFO) may have clinical benefits in severe MS. We aim to evaluate the clinical effects of PFO in rheumatic MS. Transthoracic and transesophageal echocardiography records of the patients with symptomatic severe MS were screened for the period between 2008 and 2019 in a single center. 320 symptomatic patients with severe MS were included and presence of PFO recorded. Left atrial appendix (LAA) thrombotic status was defined as clear, spontaneous echo contrast, and thrombus. Two different statistical models were used to determine the predictors of either smallest (mitral valve area) MVA at symptomatic presentation or more thrombogenic LAA. 34 patients had PFO. Multivariable ordinary least square model demonstrated that increase in systolic pulmonary arterial pressure, ejection fraction and presence of PFO were associated with smaller MVA on presentation. Multivariable proportional odds logistic regression model demonstrated that advanced age, increased left atrial diameter, absence of PFO were associated with more thrombotic status whereas larger MVA was associated with decreased thrombotic status in LAA. Presence of PFO in severe MS results in two clinical benefits as (i) being asymptomatic with smaller MVA and (ii) having less LAA thrombosis probably caused by depressurizing effect on the left atrial pressure. Our study could serve as an example for patient groups with expected symptomatic benefits from left atrium pressure offloading interventions.
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Affiliation(s)
- Gamze Babur Guler
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey.
| | - Arda Can Dogan
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Ali Kemal Kalkan
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Ali Rıza Demir
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Begum Uygur
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Ali Birant
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Hicaz Zencirkiran Agus
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Maria Concetta Pastore
- Department of Medical Biotecnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Kadriye Memiç
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Fatih Uzun
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
| | - Matteo Cameli
- Department of Medical Biotecnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Mehmet Erturk
- Cardiology Department, Mehmet Akif Ersoy Thoracic And Cardiovascular Surgery Training and Research Hospital, University Of Health Sciences Istanbul, Turgut Ozal Bulvarı no:11, 34303, Istanbul, Küçükçekmece, Turkey
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Vanhie E, VandeKerckhove K, Haas NA, De Wolf D. Atrial flow regulator for drug-resistant pulmonary hypertension in a young child. Catheter Cardiovasc Interv 2021; 97:E830-E834. [PMID: 33650782 DOI: 10.1002/ccd.29590] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/10/2022]
Abstract
This case describes the successful implantation of an Occlutech Atrial Flow Regulator in a young child with idiopathic pulmonary hypertension and recurrent syncope despite targeted combination therapy, with subsequent relief of symptoms.
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Affiliation(s)
- Ellen Vanhie
- Department of Pediatrics, Pediatric Cardiology, Amsterdam University Hospital, Amsterdam, The Netherlands
| | - Kristof VandeKerckhove
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Nikolaus A Haas
- Department of Pediatrics, Pediatric Cardiology, LMU Klinikum, München, Germany
| | - Daniel De Wolf
- Department of Pediatrics, Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.,Department of Pediatrics, Pediatric Cardiology, Brussel University Hospital, Brussels, Belgium
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10
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Paitazoglou C, Bergmann MW, Özdemir R, Pfister R, Bartunek J, Kilic T, Lauten A, Schmeisser A, Zoghi M, Anker SD, Sievert H, Mahfoud F. One-year results of the first-in-man study investigating the Atrial Flow Regulator for left atrial shunting in symptomatic heart failure patients: the PRELIEVE study. Eur J Heart Fail 2021; 23:800-810. [PMID: 33555114 DOI: 10.1002/ejhf.2119] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/16/2021] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Attenuating exercise-induced elevated left atrial pressure with an atrial shunt device is under clinical investigation for treatment of symptomatic heart failure (HF). METHODS AND RESULTS PRELIEVE was a prospective, non-randomised, multicentre, first-in-man study in symptomatic HF patients with reduced (HFrEF) or preserved (HFpEF) ejection fraction and pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg during exercise. Here, we provide follow-up data up to 1 year after implantation of the Atrial Flow Regulator (AFR) device. The AFR was successfully implanted in 53 patients (HFrEF n = 24 and HFpEF n = 29). Two patients were not enrolled due to an unsuccessful transseptal puncture. There was one device embolisation into the left atrium, which required surgical removal. One patient experienced a serious procedure-related adverse event (post-procedural bleeding and syncope). All patients with sufficient echocardiography readout confirmed device patency with left-right shunt both at 3 (n = 47/51, 92%) and 12 (n = 45/49, 92%) months. At 3 months, rest PCWP decreased by 5 (-12, 0) mmHg (P = 0.0003, median Q1, Q3). No patient developed a stroke, worsening of right heart function or significant increase of pulmonary artery pressure. Six (6/53, 11%) patients were hospitalised for worsening of HF and three (3/53, 6%) patients died. We observed improvements in New York Heart Association functional class, 6-min walking distance and quality of life (Kansas City Cardiomyopathy Questionnaire) in certain patients. CONCLUSIONS Implantation of the AFR device in HF patients was feasible. No shunt occlusion, stroke or new right HF was observed during the 1-year follow-up, with clinical improvements in certain patients.
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Affiliation(s)
| | | | - Ramazan Özdemir
- Department of Cardiology, Bezmiâlem Vakıf University, Istanbul, Turkey
| | - Roman Pfister
- Department of Cardiology, Pulmonology, Angiology and Intensive Care Medicine, Heart Center University Clinic Köln, Köln, Germany
| | - Jozef Bartunek
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Teoman Kilic
- Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Alexander Lauten
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Schmeisser
- Department of Cardiology and Angiology
- University clinic Magdeburg A.ö.R, Magdeburg, Germany
| | - Mehdi Zoghi
- Department of Cardiology, Ege University Medical Faculty, Bornova/Izmir, Turkey
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Felix Mahfoud
- Department of Internal Medicine, Cardiology, Angiology and Intensive Care Medicine, University Clinic Saarland, Homburg, Germany
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Sivakumar K, Rohitraj GR, Rajendran M, Thivianathan N. Study of the effect of Occlutech Atrial Flow Regulator on symptoms, hemodynamics, and echocardiographic parameters in advanced pulmonary arterial hypertension. Pulm Circ 2021; 11:2045894021989966. [PMID: 33614019 PMCID: PMC7869179 DOI: 10.1177/2045894021989966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 11/16/2022] Open
Abstract
Optimal sized balloon atrial septostomy improves hemodynamics in advanced pulmonary arterial hypertension. Occlutech Atrial Flow Regulator is designed to provide an atrial septal fenestration diameter titrated according to the age and right atrial pressures. This observational study analyzed symptoms, exercise distance, oxygen saturations, hemodynamics and echocardiographic parameters after Atrial Flow Regulator implantation in patients with syncope or right-heart failure. Patients with high-risk predictors of mortality during septostomy were scrutinized. Thirty-nine patients (9 children) with syncope (34/39) or right-heart failure (27/39) underwent Atrial Flow Regulator implantation without procedural complications. Six-minute walk distance increased from 310 ± 158.2 to 376.4 ± 182.6 m, none developed syncope. Oxygen saturations reduced from 96.4 ± 6.4% to 92 ± 4.9% at rest and further to 80.3 ± 5.9% on exercise. Right atrial pressures reduced from 9.4 ± 5 (2-27) mmHg to 6.9 ± 2.6 (1-12) mmHg, while cardiac index increased from 2.4 ± 0.8 (0.98-4.3) to 3 ± 1 (1.1-5.3) L/min/m2 and systemic oxygen transport increased from 546.1 ± 157.9 (256.2-910.5) to 637.2 ± 191.1 (301.3-1020.2) ml/min. Echocardiographic improvement included significant reduction of pericardial effusion and inferior caval congestion at a median follow-up of 37 months. Overall survival improved except two early and one late deaths in high-risk patients. Five of seven patients with advanced disease and key hemodynamic predictors of mortality survived. Acute hemodynamic benefits in pulmonary arterial hypertension after Atrial Flow Regulator were improved cardiac output, systemic oxygen transport, and reduced right atrial pressures. Improvement of symptoms especially syncope, exercise duration, and right ventricular systolic function as well as device patency were sustained on mid-term follow-up. Implantation was safe in all including young children without procedural complications. Mortality was noted only in patients who had high-risk predictors and patients at advanced stage of the disease.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Gopalavilasam R Rohitraj
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Monica Rajendran
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Nithya Thivianathan
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
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12
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Piccinelli E, Castro-Verdes MB, Fraisse A, Bautista-Rodriguez C. Implantation of an Atrial Flow Regulator in a Child on Venoarterial Extracorporeal Membrane Oxygenator as a Bridge to Heart Transplant: A Case Report. J Card Fail 2020; 27:364-367. [PMID: 33242607 DOI: 10.1016/j.cardfail.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Balloon dilation and stenting of the atrial septum are techniques used to unload left heart cavities in acute or end-stage heart failure in children. However, they carry significant risks such as tamponade or device embolization. CASE PRESENTATION We report the first case of a child with an end-stage mitochondrial cardiomyopathy on a venoarterial extracorporeal membrane oxygenator as a bridge to heart transplant where an atrial flow regulator device has been implanted. CONCLUSIONS This case illustrates the feasibility and safety of atrial flow regulator implantation in this setting. This procedure allowed to wean inotropic support while awaiting heart transplantation.
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Affiliation(s)
- Enrico Piccinelli
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Mireya Beatriz Castro-Verdes
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Carles Bautista-Rodriguez
- Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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13
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Hima F, Gümmer M, Prescher A, Altarawneh B, Zayat R, Hatam N, Ernst L, Kalverkamp S, Spillner J, Arias-Pinilla J. A New Percutaneous Approach to Treat Combined Right Ventricular and Respiratory Failure: The "Aachen Cannula". Eur Surg Res 2019; 60:229-238. [PMID: 31743901 DOI: 10.1159/000504411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/28/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Right ventricular failure (RVF) on its own is a life-threatening condition. Often it manifests as a two-organ failure in the final phase of several lung diseases. Mechanical circulatory support is a proven treatment of RVF but remains challenging. Our objective is to develop a novel, simplified, and minimally invasive cannula approach to treat both RVF and respiratory failure. METHODS We conceptualized a dual lumen cannula approach to allow oxygenated right-to-left shunting at an atrial level to decompress right-sided circulation. A minimally invasive approach through percutaneous, transjugular insertion and transseptal placement should enable patients to be non-sedated and even ambulatory. In an iterative design, pre-prototyping, prototyping, and anatomic fitting process, such a cannula was generated and tested in both cadaveric and fluid dynamic studies. RESULTS After various modifications and improvements, a 27-Fr 255-mm-long double-lumen cannula with an inner line (oxygenated blood return to patient into the left atrium) of 18 Fr and an inflatable balloon (with a volume of approximately 1 mL) at the outflow tip was produced - one version with a straight head and another one with a curved head. In our anatomic studies, the "Aachen Cannula" allowed an easy transjugular introduction and advancement into the right atrium by Seldinger technique. Transseptal placement was achieved by puncture (Brockenbrough needle) in combination with dilatation and was then secured in place with the stabilizing balloon, even under slight tension. The cannula prototype enabled a flow of up to 3.5 L/min, at which common pressure drops were observed. CONCLUSION In conclusion, we successfully conceptualized, designed, and verified a minimally invasive one-cannula approach for the treatment of either isolated right heart failure and even combined RVF and respiratory failure through our transseptal Aachen Cannula. This concept may also be carried out in ambulatory conditions. Moreover, this approach completely avoids recirculation issues and ensures reliable oxygenated coronary as well as cerebral perfusion.
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Affiliation(s)
- Flutura Hima
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany,
| | - Marjolijn Gümmer
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, University Hospital RWTH Aachen, Aachen, Germany
| | - Bader Altarawneh
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rachad Zayat
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Lisa Ernst
- Institute of Laboratory Animal Science, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Kalverkamp
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Jessica Arias-Pinilla
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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