heart failure (hf) interatrial shunt study 1

Conditions: Chronic Heart Failure

Summary: the objective of this study, is to assess the safety and performance of an interatrial shunt when implanted in patients with severe chronic heart failure.

this is a prospective, non-randomized, open label, single-arm multi-center study assessing the performance and safety of the v-wave inter-atrial unidirectional shunt when implanted in chronic heart failure patients with both reduced and preserved ejection fraction. the v-wave interatrial unidirectional shunt is designed to enable blood flow in a controlled manner from the left atrium to the right atrium in heart failure patients where clinical sequelae such as symptomatic pulmonary congestion due to high left atrial filling pressure is common. the objective of this study, is to assess the safety and performance of the v-wave system when implanted in patients with severe chronic heart failure. in addition, this study is designed, in-part, to collect a portion of the clinical data needed in support of a us fda pivotal ide study application to be submitted at a later date. up to 70 subjects with chronic acc/aha stage c, nyha functional class iii or ambulatory class iv heart failure (hf), with reduced or preserved lv ejection fraction, who have a history of hospitalization for worsening hf or elevated ambulatory levels of bnp/nt-probnp, in the setting of maximally tolerated guideline-directed hf drug and device therapy, will be enrolled in the study.

Eligibility criteria:
inclusion criteria: 1. ischemic or non-ischemic cardiomyopathy with either reduced or preserved lv ejection fraction and documented heart failure for at least 6 months 2. acc/aha stage c, nyha class iii or ambulatory class iv heart failure, 3. receiving maximally tolerated medical therapy for heart failure as indicated per acc/aha or esc heart failure guidelines 4. subject has a minimum of one (1) prior hospital admission within the last 12 months for acute worsening of hf associated with signs/symptoms of congestion 5. able to perform the 6-minute walk test with a distance ≥150 meters and ≤450 meters. 6. provide written informed consent for study participation exclusion criteria: 1. age \ 85 years old 2. bmi \ 40 kg/m2 3. systolic blood pressure \ 160 mmhg 4. has baseline 2-d echocardiographic evidence of, or history of, unresolved or non- organized intracardiac thrombus 5. has pulmonary hypertension with a pulmonary artery systolic pressure of ≥70 mm/hg on screening baseline echocardiogram. 6. significant rv dysfunction defined echocardiographically as tapse \<12mm or rvfac ≤30%. 7. left ventricular end-diastolic diameter (lvedd) \> 8cm 8. has an atrial septal defect or patent foramen ovale with more than trace shunting on color doppler or intravenous bubble study or prior surgical or interventional correction of congenital heart disease involving atrial septum including placement of a pfo or asd closure device 9. had a stroke, transient ischemic attack, systemic or pulmonary thromboembolism, or deep vein thrombosis (dvt) within the last 6 months, or any prior stroke with permanent neurologic defect. 10. has untreated severe stenotic or regurgitant valve lesions, or coronary stenoses which are anticipated to require surgical or percutaneous intervention within 6 months, active valvular vegetations, atrial myxoma, hypertrophic cardiomyopathy with significant resting or provoked subaortic gradient, acute myocarditis, tamponade, or large pericardial effusion, constrictive pericarditis, infiltrative cardiomyopathy (including cardiac sarcoidosis, amyloidosis, and hemochromatosis), or congenital heart disease, as cause of hf. 11. transseptal procedure is anticipated within 6 months after the v-wave shunt implant. 12. bradycardia with heart rate \<45 bpm (unless treated with a permanent pacemaker) or uncontrolled tachyarrhythmias. 13. intractable hf with resting symptoms despite maximal medical therapy (acc/aha hf stage d). 14. intolerant to both acei and arb and beta-blocker medical therapy for patients classified as hfref (ef ≤40%). 15. had an acute mi, acute coronary syndrome (acs), percutaneous coronary intervention (pci), rhythm management system revision, lead extraction, or cardiac or other major surgery within 30 days. 16. not eligible for emergency open-heart, thoracic or vascular surgery in the event of cardiac perforation or other serious complication during contemplated study device implantation. 17. has a life expectancy \<1 year due to non-cardiovascular illness. 18. has contraindications to all of the study-related anticoagulation/antiplatelet regimens 19. has an estimated glomerular filtration rate \<30 ml/min/1.73 m2 by the mdrd method or is receiving dialysis. 20. hepatic impairment with at least one liver function test 21. severe chronic pulmonary disease 22. active infection requiring systemic antibiotics. procedural (final) exclusion criteria: 1. unable to undergo both tee and ice. 2. anatomical anomaly on tee or ice 3. has inadequate vascular access for implantation of shunt. 4. hemodynamic anomaly or instability at time of fec