In vivo fluid dynamics of the Ventura interatrial shunt device in patients with heart failure
Pfeiffer, Michael (Penn State Heart and Vascular Institute (Pennsylvania, Estats Units d'Amèrica))
Boehmer, John (Penn State Heart and Vascular Institute (Pennsylvania, Estats Units d'Amèrica))
Gorcsan, John (Penn State Heart and Vascular Institute (Pennsylvania, Estats Units d'Amèrica))
Eguchi, Shunsuke (Penn State Heart and Vascular Institute (Pennsylvania, Estats Units d'Amèrica))
Orihara, Yoshiyuki (Penn State Heart and Vascular Institute (Pennsylvania, Estats Units d'Amèrica))
Perl, Michael Laufer (Tel Aviv Sourasky Medical Center)
Eigler, Neal (Cedars-Sinai Medical Center)
Abraham, William T. (The Ohio State University Wexner Medical Center)
Nuñez Villota, Julio (Universitat de València)
Lee, Elisabeth (Division of Cardiology. Rochester General Hospital)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Moravsky, Gil (Shamir Medical Center (Assaf HaRofeh))
Kar, Saibal (Cardiovascular Institute of Los Robles Health System (California, Estats Units d'Amèrica))
Zile, Michael (Medical University of South Carolina (Estats Units d'Amèrica))
Holcomb, Richard
Anker, Stefan (Charité-Universitätsmedizin Berlin)
Stone, Gregg W. (Icahn School of Medicine at Mount Sinai (Nova York, Estats Units d'Amèrica))
Rodes-Cabau, Josep (Quebec Heart & Laval University (Quèbec, Canada))
Lindenfeld, JoAnn (Vanderbilt University Medical Center)
Bax, Jeroen J. (Leiden University Medical Center)

Date:	2024
Abstract:	Aims: Interatrial shunts are under evaluation as a treatment for heart failure (HF); however, their in vivo flow performance has not been quantitatively studied. We aimed to investigate the fluid dynamics properties of the 0. 51 cm orifice diameter Ventura shunt and assess its lumen integrity with serial transesophageal echocardiography (TEE). Methods and results: Computational fluid dynamics (CFD) and bench flow tests were used to establish the flow-pressure relationship of the shunt. Open-label patients from the RELIEVE-HF trial underwent TEE at shunt implant and at 6 and 12 month follow-up. Shunt effective diameter (D) was derived from the vena contracta, and flow was determined by the continuity equation. CFD and bench studies independently validated that the shunt's discharge coefficient was 0. 88 to 0. 89. The device was successfully implanted in all 97 enrolled patients; mean age was 70 ± 11 years, 97% were NYHA class III, and 51% had LVEF ≤40%. Patency was confirmed in all instances, except for one stenotic shunt at 6 months. D remained unchanged from baseline at 12 months (0. 47 ± 0. 01 cm, P = 0. 376), as did the trans-shunt mean pressure gradient (5. 1 ± 3. 9 mmHg, P = 0. 316) and flow (1137 ± 463 mL/min, P = 0. 384). TEE measured flow versus pressure closely correlated (R ≥ 0. 98) with a fluid dynamics model. At 12 months, the pulmonary/systemic flow Qp/Qs ratio was 1. 22 ± 0. 12. Conclusions: When implanted in patients with advanced HF, this small interatrial shunt demonstrated predictable and durable patency and performance.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	ESC Heart Failure, Vol. 11 Núm. 5 (october 2024) , p. 2499-2509, ISSN 2055-5822

DOI: 10.1002/ehf2.14859
PMID: 38773938

11 p, 1.5 MB

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