Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure : first-inman experience with the V-Wave device
Aims: Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with
chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA
pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience
with the V-Wave device.
Methods and results: A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular
dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and
orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of
an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains
a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The
procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance.
The device was successfully implanted and the patient was discharged 24 hours after the procedure with no
complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The
patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from
39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the
pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function.
Conclusions: Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new
concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of
applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was
associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days
