Heart Failure

ALT-FLOW and the HF Shunt Alternative

Although heart failure prognosis is grim, the ALT-FLOW trial’s two year results suggest that diverting blood from the left atrium to the coronary sinus using a shunt could have lasting benefits for patients with HFmrEF/HFpEF.

  • There’s no cure for HF, so most treatments focus on extending lifespan and improving quality-of-life by reducing symptoms.
  • Current treatments focus on improving blood flow, lowering blood pressure, and relieving kidney fluid pressure, while procedures like CABG or ICD and VAD implantation help avoid HF complications.

Taking a different approach to HF therapy, researchers gave 95 patients the Edwards APTURE Transcatheter Shunt System and found that it improved HF symptoms, quality-of-life, and functional capacity after 2 years.

  • Starting off, most patients had NYHA class III symptoms (92.6%) and over a third had been previously hospitalized for HF (37.9%).
  • By year two, this improved to 85.5% of patients experiencing class I or II symptoms.
  • Shunt implantation also led to improved KCCQ scores, up from a mean of 38.1 points at baseline to 69.8 by year two.
  • The APTURE shunt also led to functional improvement, with the 6-minute mean walk distance increasing from 247.5m at baseline to 307.2m by year two.

That’s a pretty impressive two-year improvement – and the cherry on top? APTURE didn’t lead to the adverse effects on right heart structure or function that were common in other HF shunt trials.

However, the study isn’t perfect due to its single-arm design, which means it’s unclear how these benefits would stack up against a control group.

  • Sham-controlled studies for other HF shunts have not shown significant improvements in prognosis or symptoms.
  • We’ll get more definitive answers from APTURE’s ongoing ALT-FLOW II randomized controlled trial for hemodynamic changes in symptomatic HF patients with stable GDMT.

The Takeaway

While the APTURE system has more to prove, this early feasibility study suggests that the shunt has potential to become an important HF therapy if follow-up trials confirm these results are more than just a happy coincidence.

Get twice-weekly insights on the biggest stories shaping cardiology.

You might also like

Cardiac Imaging June 16, 2025

Beyond Hardware: Is AI the Answer to Making Cardiac Imaging more Accessible? June 16, 2025

Sponsored by Philips Healthcare Cardiac imaging has traditionally improved through hardware advances, enabling the speed needed for high-quality images. However, hardware is rapidly reaching its physical limitations in suppressing cardiac motion and represents a large financial investment. Today, software and AI are driving the next leap in cardiac image quality and motion control – offering […]

Cardiology Pharmaceuticals June 12, 2025

FDA Approves a New BP Triple Polypill June 12, 2025

Bringing a more effective BP therapy to the U.S. market, the FDA approved George Medicines’ triple therapy polypill called Widaplik for patients with hypertension, making it the first of its kind to go to market in the U.S. Widaplik’s approval stems from two studies, including one comparing the polypill against placebo as an initial treatment […]

Cardiology Pharmaceuticals June 12, 2025

Pharmacologic Preconditioning to Improve Outcomes in Patients Undergoing Cardiac Surgery  June 12, 2025

The majority of patients undergoing cardiac surgery, especially those on cardiopulmonary bypass (CPB), experience post-operative complications such as new-onset atrial fibrillation (POAF) and acute kidney injury (AKI), largely driven by oxidative stress and inflammation.   Several approaches have been explored to reduce complications following cardiac surgery, however, a clinically meaningful impact has yet to be realized.  […]

This content is exclusive to subscribers

Log in or join by entering your email below.

Completely free. Every Monday and Thursday.

CW Phone Square

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Cardiac Wire Team

You're all set!