Heart failure with preserved ejection fraction is responsible for half of all heart failure and confers substantial morbidity and mortality, and yet to date, there have been no effective pharmacologic interventions. Although the pathophysiology is complex, the primary aetiology of exercise intolerance is due to an elevated left atrial pressure, particularly with exercise. In this context, device-based therapy has become a focus. Several companies have developed techniques to percutaneously create an iatrogenic left to right shunt at the atrial level, thereby reducing left atrial pressure and reducing transmitted pressures to the pulmonary circulation and reducing pulmonary congestion. In this review, we explore the pathophysiology, evidence base, benefits, and considerations of these devices and their place in the therapeutic landscape of heart failure with preserved ejection fraction.

射血分数保留的心力衰竭占所有心力​​衰竭的一半，并导致大量的发病率和死亡率，但迄今为止，尚无有效的药物干预措施。尽管病理生理学很复杂，但运动不耐受的主要原因是左心房压力升高，尤其是运动时。在此背景下，基于设备的治疗已成为焦点。几家公司已经开发出经皮在心房水平产生医源性左向右分流的技术，从而降低左心房压力并减少传递到肺循环的压力并减少肺充血。在这篇综述中，我们探讨了这些设备的病理生理学、证据基础、益处和考虑因素，以及它们在射血分数保留的心力衰竭治疗领域中的地位。