Improvement of Hemodynamics and Quality of Life Before and After Interatrial Shunt Devices Implantation for Chronic Heart Failure: A Systematic Review and Meta-analysis

Objective: The objective of this study was to compare the quality of life and hemodynamic changes before and after transcatheter atrial septal shunt implantation. Methods: A systematic search was conducted in the Cochrane Library, PubMed, and Embase from inception to September 2023 for studies reporting on hemodynamics or quality of life in patients with chronic heart failure after atrial septal shunt implantation. A meta-analysis was performed, in which a total of 1026 participants from 13 articles were included. Results: Following the implantation, pulmonary capillary wedge pressure (PCWP) decreased by 2.60 mmHg. Right atrial pressure (RAP) increased by 1.30 mmHg and left ventricular ejection fraction (LVEF) increased by 2.13%. However, there were no significant differences in cardiac output and mean pulmonary artery pressure (mPAP) after operation. Minnesota Living with Heart Failure (MLWHF) Score decreased by -19.28, while the Kansas City Cardiomyopathy Questionnaire (KCCQ) score increased by 25.41. Moreover, 6-minute walking distance (6MWD) increased by 32.22 m. The results of subgroup analysis showed that for patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF), LVEF increased by 3.09% while CO increased by 1.01 L/min after operation. Meanwhile, PCWP significantly decreased by 2.67 mmHg and MLWHF scores decreased by 19.28. Additionally, 6MWD significantly increased by 27.5 m. However, there were no significant changes in RAP and mPAP after operation. For patients with heart failure with reduced ejection fraction (HFrEF), interatrial shunt device implantation did not achieve a significant increase in LVEF. Conclusion: These findings suggest that while atrial septal shunt implantation might not yield LVEF elevation among patients with HFrEF, it improves hemodynamic parameters, exercise endurance, and QoL among individuals with HFpEF/HFmrEF.