Wheezing, tiredness, the breath that stops in the throat. All symptoms of heart failure, a disease as widespread as it is disabling: it affects about 14 million Europeans and in Italy 2% of the population: about 1,200,000 people, with an average growth of 2.3% over the next 10 years. Now, however, a minimally invasive, innovative and cutting-edge technique enters the scene, to treat heart failure that cannot be controlled with drugs, and therefore offer patients a better expectation and quality of life. The surgery involves the implantation of a new device – Atrial Flow Regulator -. It was performed, for the second time in Italy, at the Sant’Ambrogio Clinical Institute in Milan, a center of excellence for interventional cardiology, by Dr. Maurizio Tespili, (head of the Cardiology Operating Unit and coordinator of the cardiological area of Bergamo Hospital Institutes) and his team (doctors Alfonso Ielasi, Massimo Medda, Francesco Casilli, Marta Bande and Mariano Pellicano).
What’s this?
But what is heart failure? It is the inability of the heart to perform the normal contractile pump function and to guarantee the correct blood supply to all organs. It is not always easily diagnosed; in the early stage, in fact, the disease can be asymptomatic. Cases are more frequent with increasing age, and progressively more are counted among women, reaching 15% in both sexes in people aged 85 and over. Due to the progressive aging of the general population, heart failure has taken on an increasingly important epidemiological dimension and currently represents the cardiovascular disease with the highest prevalence and incidence.
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Symptoms and causes
It occurs with breathlessness, fatigue, rapid heart rate, swelling in the legs or abdomen. It can have different causes, including hypertension, heart attack, hereditary predisposition, inflammatory diseases and is bound to worsen over time. The new technique allows you to treat it in an innovative way. “This percutaneous interatrial septostomy procedure with Atrial Flow Regulator represents, in effect, a completely new way to treat heart failure – confirms Tespilli -. A revolutionary concept of intervention that, unlike traditional techniques, acts on the heart thanks to a small hole (about 8-10 mm) that allows to “lighten” the filling pressures of the left ventricle by creating a connection between the left and right atrium, thus clearly improving the symptoms related to heart failure “
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The treated patient
The operation was performed on a 55-year-old patient suffering from moderate post-infarct systolic dysfunction of the left ventricle and who had previously undergone several percutaneous coronary angioplasties. “Despite adequate medical therapy for heart failure, the patient continued to complain of constant symptoms, such as severe difficulty in breathing (dyspnoea), even for mild exertion. Not being a candidate for a transplant, we had to resort to an alternative but effective procedure that allowed him to increase not only life expectancy but also the quality of life itself “.
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The intervention
The operation lasts about 40 minutes, is performed under general anesthesia and consists in creating an interatrial communication (between left and right atrium) through a hole in which a small and innovative ring-shaped device (Atrial Flow Regulator) is implanted (in nitinol, a special metal alloy), which guarantees a deviation of the blood flow from left to right (of the atrial cavities) with relative reduction of the left atrial intracavitary pressure and indirectly of the pulmonary capillary pressure, the increase of which may be responsible for dyspnea on exertion.
In practice, the procedure is performed via the femoral trans-venous route: after the transseptal puncture and after placing the wire inside the left upper pulmonary vein, the atrial septum is dilated with a balloon of suitable caliber (12-14 mm) . Subsequently, the delivery system (catheter) is advanced through which the device (AFR) is made to pass and is finally progressively coupled to the interatrial septum. Once positioned, the device does not need to be replaced
The benefits
Available data from international studies demonstrate clear benefits in follow-up, including a significant reduction in symptoms and hospitalizations, associated with an improvement in functional capacity. «Being a minimally invasive and percutaneous technique with access from the femoral vein, there is no surgical wound and the painful symptoms are almost absent – concludes Tespilli -. The patient returned home three days after the operation, without having to resort to rehabilitation cycles, but only with the indication to periodically undergo ultrasound and clinical check-ups agreed with the specialist. In conclusion, we can say that this intervention represents a great technological innovation, but with an important practical impact in the daily care of patients with heart failure, an effective, cutting-edge and safe weapon against an increasingly widespread and disabling disease “.
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