Transcatheter Atrial Shunting in Patients With Heart Failure: A Systematic Review and Meta-Analysis.

Despite improvements in heart failure (HF) management, there is still a significant residual risk for adverse events in both trial and real-world settings. Transcatheter atrial shunting is a novel intervention aiming to restore normal hemodynamics and thus improve outcomes. The aim of this systematic review and meta-analysis is to evaluate its effect on functional, hemodynamic, and clinical outcomes. A systematic search was performed in 3 databases. Following study selection, a meta-analysis was performed. For continuous outcomes, the mean difference (MD) from baseline, along with the 95% confidence interval (95% CI), and, for dichotomous outcomes, the risk ratio (RR) and the respective 95% CI were calculated. A total of 12 studies and 1521 patients were included in the analysis. At a mean follow-up of 11.5 months, the 6-minute walking distance (MD: 39.29; 95% CI, 18.96-59.63) and the Kansas City Cardiomyopathy Questionnaire score (MD: 19.71; 95% CI, 12.82-26.60) significantly increased. Atrial shunting significantly reduced resting (MD: -2.90; 95% CI, -4.10 to -1.70) and peak exercise pulmonary capillary wedge pressure (MD: -3.20; 95% CI, -5.14 to -1.26), while the mean right atrial pressure significantly increased (MD: 1.33; 95% CI, 0.73-1.92). No significant effect was found in all-cause mortality (RR: 1.27; 95% CI, 0.82-1.99), major adverse cardiovascular events (RR: 1.27; 95% CI, 0.36-4.45), or HF hospitalization (RR: 1.27; 95% CI, 0.36-4.45). In HF patients, atrial shunting provides significant improvement in exercise capacity, quality of life, and hemodynamics. The absence of clinical benefit necessitates further randomized studies focusing on specific phenotypes in order to optimize patient selection and prove clinical effect.