Can creating a shunt between the left atrium and the coronary sinus improve symptoms for patients with heart failure with preserved ejection fraction (HFpEF)?

In this in-depth discussion, Dr. Andrei Pop and Dr. Firas Zahr, PI of the ALT-FLOW II Trial, explore the science, physiology, and patient selection behind one of the most intriguing new frontiers in interventional heart failure.

Key takeaways:

What makes ALT-FLOW different from previous intra-atrial shunt devices

How shunt location, size, and flow patterns affect outcomes

Which heart failure patients respond best — HFpEF, HFrEF, or mixed phenotypes

Why resting wedge pressures don’t predict exercise hemodynamics

The importance of exercise right heart catheterization and PCWL measurement

Insights on stroke risk and why preserving the atrial septum may matter for lifetime procedures

How ALT-FLOW maintains procedural simplicity and safety through the coronary sinus approach

Expanding the field of interventional heart failure and device-based diastolic therapies

This conversation is essential for structural heart and heart failure specialists exploring new options for symptomatic HFpEF patients in the modern era of shunt-based therapy.

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Chapters:

00:00 – Intro: The rise of interventional heart failure

00:45 – What makes the ALT-FLOW device unique

01:20 – Lessons learned from prior shunt trials

02:30 – Which patients may benefit most

04:00 – Persistent symptoms after valve repair and TAVR

05:00 – Stroke risk and shunt design safety

06:30 – Importance of preserving the interatrial septum

07:00 – Exercise right heart catheterization and PCWL

08:30 – What exercise reveals about true physiology

10:30 – When wedge pressures tell the real story

12:00 – Expanding tools for diastolic dysfunction

13:30 – Sham control and endpoint selection in ALT-FLOW II

15:30 – Heart failure specialists re-engaging with HFpEF

17:00 – Pacemaker leads and coronary sinus access

18:00 – Future of interventional heart failure

19:30 – Industry, innovation, and economics of device therapy

21:00 – Safety data and operator experience so far

23:00 – Future: Finding the right HFpEF subsets

24:30 – Closing reflections and next steps in research

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