Heart Failure Heart Failure Treatment by Device Antoni Bayés-Genis Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain Disclosure: ABG was supported by CIBER Cardiovascular (CB16/11/00403). Citation: European Cardiology Review 2020;15:e17. DOI: https://doi.org/10.15420/ecr.2020.03 Correspondence: Antoni Bayés-Genis, Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n 08916, Barcelona, Spain. E: abayesgenis@gmail.com Open Access: This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non- commercial purposes, provided the original work is cited correctly. “Science can amuse and fascinate us all, but it is engineering that The history of the MitraClip begins with advances in the surgical changes the world.” treatment of mitral regurgitation. The MitraClip technology draws on – Isaac Asimov, 1920–1992 experience with surgical edge-to-edge mitral valve repair, which was first reported by Alfieri et al. in 1995.4 This technique involves the Technological breakthroughs, particularly advances in devices, are placement of sutures to anchor the free edge of a leaflet to its changing the course of heart failure (HF) management. Implantable corresponding opposite leaflet, creating two valve orifices without the devices have been used for decades to treat heart disease. The first need for annuloplasty. pacemaker was implanted over 60 years ago (October 1958), and implantable defibrillators were first used in the early 1980s. Cardiac Based on these findings, investigators at major academic institutions, resynchronisation therapy appeared at the turn of the century. in concert with private industry (Evalve; later Abbott Vascular), However, the past few years have witnessed a surge in both the types developed the MitraClip percutaneous transcatheter method to of devices being tested for HF treatment and the optimism of experts reapproximate the anterior and posterior mitral leaflets as a therapy for about their usefulness. mitral regurgitation. This method was first described in pigs in 2003, and several trials have since tested the value of MitraClip in the This HF Special Focus Section reviews novel devices used for advanced, treatment of severe mitral regurgitation, with controversial results. symptomatic HF. Destination left ventricular assist devices (LVADs) in non-transplant centres, interatrial shunts to treat HF and MitraClip in HF In this HF Special Focus Section, these data are discussed and put are discussed by Bayés-Genis, Rodés-Cabau and Linderfeld. into a clinical context to better understand the real clinical value of MitraClip in 2020. The history of mechanical circulatory support began in 1953, when John H Gibbon reported the first successful use of extracorporeal The interatrial shunt is the newest of the three devices discussed in this circulation by means of an oxygenator. In 1966, DeBakey implanted the special issue. Increased left atrial pressure leading to pulmonary first pneumatically driven LVAD,1 and in 1969, Cooley implanted the first congestion is the common mechanism precipitating symptom total artificial heart, intended as a bridge to transplantation.2 It was not worsening and acute decompensation in chronic HF patients. Some until 1982 that the Jarvik-7 artificial heart was implanted for the first evidence supports interatrial shunting to relieve the excess volume time with the intention of permanent treatment, although the patient from the left to right atrium regulated by the interatrial pressure died within 4 months of severe sepsis and multi-organ failure.3 gradient. A shift from the concept of a complete artificial heart towards the Two different interatrial shunt devices are currently being tested in development of single chamber pumps as cardiac support initiated the large randomised clinical trials: the interatrial shunt device (Corvia LVAD era. First-generation ventricular assist devices were either Medical) and the V-Wave device (V-Wave). Both are intended for pneumatically or electrically driven membrane pumps, such as the symptomatic HF; the interatrial shunt device is focused on heart failure Berlin Heart EXCOR (Berlin Heart) and Thoratec PVAD (Thoratec). with preserved ejection fraction, whereas the V-Wave device is being tested in both heart failure with preserved ejection fraction and heart In the past decade, LVAD systems have undergone substantial progress failure with reduced ejection fraction.5 in size, durability, reliability and noise emission, such as the HeartMate 3 (Abbott Structural Heart). LVAD implantation became a new treatment We have truly entered the era of devices in HF, and I believe there will option for end-stage HF, as destination therapy for patients either too be rapid progress on multiple fronts in the next few years. These old or not suitable for transplantation due to other medical conditions. devices would have been completely unimaginable a few decades ago, Consequentially, an exponential increase in LVAD implantations has and exemplify the role that industry and technology play in modern occurred in the past 5 years. medical care. © RADCLIFFE CARDIOLOGY 2020 Access at: www.ECRjournal.com Heart Failure Furthermore, while advances in devices are impressive, it is likely that bridge to recovery, where we place devices and hope that whatever is we are only in the early stages of their development. These new wrong with the heart naturally works itself out. What we may see in devices may just be the second wave designed for different aspects the future is an ‘active’ bridge to recovery, where we not only place of HF treatment, after implantable defibrillators and cardiac the device, but administer cells, genes or new (or even old) drugs to resynchronisation therapy. What we do now may be called a ‘passive’ help repair the heart. 1. DeBakey ME. Left ventricular bypass pump for cardiac PMID: 4899910. Cardiothorac Surg 1995;9:621–6. https://doi.org/10.1016/S1010- assistance. Clinical experience. Am J Cardiol 1971;27:3–11. 3. DeVries WC, Anderson JL, Joyce LD, et al. Clinical use of the 7940(05)80107-1;PMID: 8751250. https://doi.org/10.1016/0002-9149(71)90076-2; PMID: 5538711. total artificial heart. N Engl J Med 1984;310:273–8. https:// 5. Guimaraes L, Lindenfeld J, Sandoval J, et al. Interatrial shunting 2. Cooley DA, Liotta D, Hallman GL, et al. Orthotopic cardiac doi.g/10.1056/NEJM198402023100501; PMID: 6690950. for heart failure current evidence and future perspectives. prosthesis for two-staged cardiac replacement. Am J Cardiol 4. Fucci C, Sandrelli L, Pardini A, et al. Improved results with EuroIntervention 2019;15:164–71. https://doi.org/10.4244/EIJ-D- 1969;24:723–30.https://doi.org/10.1016/0002-9149(69)90460-3; mitral valve repair using new surgical techniques. Eur J 18-01211; PMID: 3080393. EUROPEAN CARDIOLOGY REVIEW