Corvia atrial shunt system: Mean LA pressure reduction device in HFpEF

Corvia atrial shunt system: Mean LA pressure reduction device in HFpEF

April 18, 2024 by dr s venkatesan

Lowering the raised LA mean pressure is a major therapeutic goal in any severely symptomatic left heart disease, whether it is valvular or myocardial disease. It is prudent to understand, that even in systolic LV failure; it is the raised LVEDP that causes the symptoms and marks the limits of exercise capacity. Drugs like inotropes, pre-load , afterload modulators like diuretics and vasodilators can take care to a certain extent.

When symptoms are refractory and the underlying condition has no primary correction , we need to intervene with some extreme procedures. We know a small ASD decompresses mitral stenosis, and the combination of ASD and MS, Lutembacher, is a well-known syndrome called Lutembacher. The concept of LA flow regulator or decompressor came from this .

When the left ventricle is stiffened and restrictive, and LA mean pressure is prohibitively high,we have a viable option now. This is to create a small regulatory orifice in the IAS ( A complicated term for a small ASD) to decompress the LA and reduce pulmonary congestive symptoms. Curious minds might ask, can’t we decompress LV it self by creating a small VSD. Probably in the thin membranous area. May be, it will come soon in the innovative lanes of cardiology.

As of now, we have an important human study REDUCE LAP-HF II , from Chicago with a 2-year follow-up up .The device used here was Corvia atrial shunt system.

The study finds the device can be beneficial without compromising much on RV side function.

Animation Courtesy: Corvia website; The procedure looks simple when compared with other procedures inside the LA .The device looks like an octopus, and sits on either side of IAS, like a stapler and maintains the orifice.

Here is an audio podcast from the primary author published in JAMA network.

Interview with Sanjiv J. Shah, author of Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction: The REDUCE LAP-HF II Randomized Clinical Trial. Hosted by James E. Udelson,

Final message

This device’s core concept lies in requesting the right ventricle to help its bigger brother LV at its difficult times. You can call this an artificially created interventricular dependence. Though it might help, we need to watch the right heart’s dynamics closely. Maybe, if RV is experiencing difficulty, we can have external control over the IAS orifice and flow as and when required. (This is not new, a remote-controlled switch regulation was done for pulmonary banding in children with congenital heart disease who needed regulation of pulmonary flow by a device FloWatch-R-PAB  (Ref 2)

It is logical to expect the same device would be useful to decompress RA at high pressures as in severe primary pulmonary hypertension. If you think backwards, it looks the same as a life-saving, reverse Rashkind procedure variant in adult

Reference

1.Patel RB, Silvestry FE, Komtebedde J, et al. Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction: The REDUCE LAP-HF II Randomized Clinical Trial. JAMA Cardiol. 

2.Antonio F Corno, et al JTVS 2003 Remote controlled pulmonary artery banding