张长东,钟禹成,李庚,吴杰,田军,荆志成,马为,董念国,吴永健,周达新,尚小珂

• 1:华中科技大学同济医学院附属协和医院心脏大血管外科
• 2:广东省人民医院心内科
• 3:北京大学第一医院心内科
• 4:国家心血管病中心北京协和医学院中国医学科学院阜外医院心内科

摘要(Abstract)：

中国已成为全球心力衰竭负担最大的国家，而且在改善预后药物普遍应用的今天，心力衰竭的死亡率仍然很高，出院后1年高达13.7%，尤其是射血分数降低的心力衰竭患者更甚。心力衰竭的介入器械治疗（结构性干预）是指针对于治疗心力衰竭的结构性因素，包括心房压力、心室重构和瓣膜介入治疗等，利用心脏自身生理特性和病理进展机制，通过无源性外力干预进行治疗，实现解剖修复或功能修复，其已日渐成为一项蓬勃发展的新兴领域，在心力衰竭管理中发挥着越来越重要的作用。本文对2024年心力衰竭（包括部分心肌病）介入治疗领域中的最新进展进行了全面梳理与总结，回顾了各种不同的正在研究阶段的新技术和新产品，以期细致剖析心力衰竭介入治疗的现状与未来，不断推动学科的进步。

关键词(KeyWords)： 心力衰竭;介入治疗;结构性干预;心脏重构;心肌病;心房分流;左心辅助;压力监测

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目(2021YFA1101900)

作者(Author): 张长东,钟禹成,李庚,吴杰,田军,荆志成,马为,董念国,吴永健,周达新,尚小珂

参考文献(References)：

• [1] Wang H, Li Y, Chai K, et al. Mortality in patients admitted to hospital with heart failure in China:a nationwide cardiovascular association database-heart failure centre registry cohort study[J]. Lancet Glob Health, 2024, 12(4):e611-e622.DOI:10.1016/S2214-109X(23)00605-8.
• [2] Hahn RT, Lindenfeld J, Lim SD, et al. Structural cardiac interventions in patients with heart failure:JACC Scientific Statement[J]. J Am Coll Cardiol, 2024, 84(9):832-847.DOI:10.1016/j.jacc.2024.05.061.
• [3] Katzianer D, Albert C. Structural interventions in heart failure:mending a broken heart[J]. J Clin Med, 2023, 12(9):3243. DOI:10.3390/jcm12093243.
• [4] Kir D, Munagala M. Restructuring the heart from failure to success:role of structural interventions in the realm of heart failure[J]. Front Cardiovasc Med, 2022, 9:839483. DOI:10.3389/fcvm.2022.839483.
• [5] Rodés-Cabau J, Lindenfeld J, Abraham WT, et al. Interatrial shunt therapy in advanced heart failure:outcomes from the openlabel cohort of the RELIEVE-HF trial[J]. Eur J Heart Fail,2024, 26(4):1078-1089. DOI:10.1002/ejhf.3215.
• [6] Paitazoglou C, Bergmann MW, Kilicaslan B, et al. Treatment with an interatrial shunt in heart failure:1-year outcomes of the PRELIEVE study[J]. JACC Heart Fail, 2024, 12(3):591-594.DOI:10.1016/j.jchf.2023.10.013.
• [7] Urey MA, Hibbert B, Jorde U, et al. Left atrial to coronary sinus shunting for treatment of heart failure with mildly reduced or preserved ejection fraction:the ALT FLOW early feasibility study 1-year results[J]. Eur J Heart Fail, 2024, 26(4):1065-1077.DOI:10.1002/ejhf.3241.
• [8] Udelson JE, Barker CM, Wilkins G, et al. No-implant interatrial shunt for HFpEF:6-month outcomes from multicenter pilot feasibility studies[J]. JACC Heart Fail, 2023, 11(8Pt 2):1121-1130. DOI:10.1016/j.jchf.2023.01.024.
• [9] Zhang CD,Zhong Y,Li Q,et al. AS-1325 impact of atrial shunt device on prognosis and risk factors in heart failure with reduced ejection fraction(SUSTAIN-HF):a national, multicenter,phaseⅢ，single group clinical study[J]. JACC, 2025, 85(14_Supplement):D7. DOI:10.1016/j.jacc.2025.03.474.
• [10] Sun W,Zou H,Yong Y, et al. The RAISE trial:a novel device and first-in-man trial[J]. Circ Heart Fail,2022,15(4):e008362. DOI:10.1161/CIRCHEARTFAILURE.121.008362.
• [11] Stone GW, Lindenfeld J, Rodés-Cabau J, et al. Interatrial shunt treatment for heart failure:the randomized RELIEVE-HF trial[J]. Circulation, 2024, 150(24):1931-1943. DOI:10.1161/CIRCULATIONAHA.124.070870.
• [12] L i t w i n S E , K o m t e b e dde J, Borlaug BA, et al. Long term safety and outcomes after atrial shunting for heart failure with preserved or mildly reduced ejection fraction:5-year and 3-year follow-up in the REDUCE LAP-HFⅠandⅡtrials[J]. Am Heart J, 2024, 278:106-116. DOI:10.1016/j.ahj.2024.08.014.
• [13] Gustafsson F, Petrie MC, Komtebedde J, et al. 2-Year outcomes of an atrial shunt device in HFpEF/HFmrEF:results from REDUCE LAP-HFⅡ[J]. JACC Heart Fail, 2024, 12(8):1425-1438. DOI:10.1016/j.jchf.2024.04.011.
• [14]常三帅，刘新民，姜正明，等.心房分流术研究进展及启示[J].中国介入心脏病学杂志，2024,32(8):463-467.DOI:10.3969/j.issn.1004-8812.2024.08.008.
• [15] Bruckheimer E. Controlled pulmonary banding for dilated cardiomyopathy:RESTORE medical clinical results[EB/OL].(2024-06-05)[2025-06-14]. https：//www.tctmd.com/slide/controlled-pulmonary-banding-dilated-cardiomyopathy-restoremedical-clinical-results.
• [16] S c h r a n z D , R u p p S , Mül ler M, et al. Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy:a novel therapeutic strategy before heart transplantation[J]. J Heart Lung Transplant, 2013, 32(5):475-481. DOI:10.1016/j.healun.2013.01.988.
• [17] S c h r a n z D , A k i n t u e r k H , B a i ley L. Pulmonary artery banding for functional regeneration of end-stage dilated cardiomyopathy in young children:world network report[J]. Circulation, 2018, 137(13):1410-1412. DOI:10.1161/CIRCULATIONAHA.117.029360.
• [18] Schranz D, Krause U, Kerst G, et al. Functional regeneration of dilated cardiomyopathy by transcatheter bilateral pulmonary artery banding：fi rst-in-human case series[J]. Eur Heart J Case Rep, 2023, 7(2):ytad052. DOI:10.1093/ehjcr/ytad052.
• [19] Sperotto F, Lang N, Nathan M, et al. Transcatheter palliation with pulmonary artery fl ow restrictors in neonates with congenital heart disease:feasibility, outcomes, and comparison with a historical hybrid stage 1 cohort[J]. Circ Cardiovasc I n t e r v , 2 0 2 3 , 1 6(1 2):e 0 1 3 3 8 3. D O I:1 0. 11 6 1/CIRCINTERVENTIONS.123.013383.
• [20] Dou Z,He Q,Ma K,et al. Pulmonary artery banding for cardiomyopathy in young children：fi rst trial in China[J]. ESC Heart Fail, 2024, 11(6):3854-3861. DOI:10.1002/ehf2.14978.
• [21] Zeng M, Yang F, Yue C, et al. Pulmonary artery banding in infants and young children with end-stage left ventricular dilated cardiomyopathy:cohort study[J]. Int J Surg, 2025, 111(1):146-152. DOI:10.1097/JS9.0000000000002061.
• [22] Hamid N , Jorde U P , Reisman M, et al. Transcatheter left ventricular restoration in patients with heart failure[J]. J Card Fail, 2023, 29(7):1046-1055. DOI:10.1016/j.cardfail.2023.03.003.
• [23] Nappi F, Lusini M, Spadaccio C, et al. Papillary muscle approximation versus restrictive annuloplasty alone for severe ischemic mitral regurgitation[J]. J Am Coll Cardiol, 2016, 67(20):2334-2346. DOI:10.1016/j.jacc.2016.03.478.
• [24] Sievert H.Remodeling the LV by approximating the bases of the papillary muscles:the V-sling approach[EB/OL].(2024-03-04)[2025-06-14]. https：//www.tctmd.com/slide/remodeling-lvapproximating-bases-papillary-muscles-v-sling-approach.
• [25] Inestroza K,Mijares-Rojas I,Matute-Martínez C,et al. Inhospital outcomes of septal myectomy vs. alcohol septal ablation for hypertrophic cardiomyopathy with outfl ow tract obstruction:an update and insights from the national inpatient sample from2011 to 2019[J]. J Investig Med,2024,72(3):262-269.DOI:10.1177/10815589241226959.
• [26] Mentias A, Smedira NG, Krishnaswamy A, et al. Survival after septal reduction in patients >65 years old with obstructive hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2023,81(2):105-115. DOI:10.1016/j.jacc.2022.10.027.
• [27] Cui H, Schaff HV, Wang S, et al. Survival following alcohol septal ablation or septal myectomy for patients with obstructive hypertrophic cardiomyopathy[J]. J Am Coll Cardiol, 2022,79(17):1647-1655. DOI:10.1016/j.jacc.2022.02.032.
• [28] Greenbaum AB,Ueyama HA,Gleason PT, et al. Transcatheter myotomy to reduce left ventricular outflow obstruction[J]. J Am Coll Cardiol,2024,83(14):1257-1272. DOI:10.1016/j.jacc.2024.02.007.
• [29] Alyaydin E, Jánosi RA, Luedike P, et al. Septal microsphere embolization in hypertrophic obstructive cardiomyopathy[J]. Am J Cardiol, 2023, 201:116-122. DOI:10.1016/j.amjcard.2023.06.006.
• [30] S h u v y M , P o s t e l l Y Y , C a r asso S, et al. Mitral valve interventions for hypertrophic obstructive cardiomyopathy[J]. Can J Cardiol, 2024, 40(5):860-868. DOI:10.1016/j.cjca.2023.12.009.
• [31] Xu L, Miao C, Wang P, et al. Radiofrequency ablation for patients with hypertrophic obstructive cardiomyopathy accompanied by severe left ventricular outfl ow tract obstruction[J]. Anatol J Cardiol, 2024, 28(12):599-605.DOI:10.14744/AnatolJCardiol.2024.4486.
• [32]方臻飞.经导管消融治疗梗阻性肥厚型心肌病的最新进展[EB/OL].(2024-06-23)[2025-06-14]. https：//www.valgenmed.com/about/news/51.html.
• [33] Long X, Deng S, Liu W, et al. Transcoronary radiofrequency ablation for obstructive hypertrophic cardiomyopathy:a feasibility study[J]. Eur Heart J, 2024, 45(3):233-235.DOI:10.1093/eurheartj/ehad741.
• [34] Li X, Zhu Z, Liu J, et al. Septal radioablation therapy for patients with hypertrophic obstructive cardiomyopathy:firstin-human study[J]. Eur Heart J Open, 2023, 3(3):oead052.DOI:10.1093/ehjopen/oead052.
• [35] Chang R, Luo D, He W, et al. A novel method for septal reduction therapy by three-dimensional guided transvenous intraseptal pulsed-fi eld ablation[J]. Heart Rhythm, 2024, 21(3):258-267. DOI:10.1016/j.hrthm.2023.11.020.
• [36] Wang S,Dong Z,Liu Z,et al. Minimally invasive electro septal myectomy for hypertrophic obstructive cardiomyopathy via right infra-axillary incision[J]. Ann Thorac Surg,2 0 2 5 , S 0 0 0 3-4 9 7 5(2 5)0 0 9 8 4-1. D O I:1 0. 1 0 1 6/j.athoracsur.2025.09.023.
• [37] Zhou M, Li Z, Liu Y, et al. Transapical intramyocardial septal microwave ablation in treatment of hypertrophic obstructive cardiomyopathy:12-month outcomes of a swine model[J]. J Cardiothorac Surg, 2024, 19(1):205. DOI:10.1186/s13019-024-02677-z.
• [38] Lu X,Li J,Hsi DH,et al. Feasibility and safety of percutaneous intramyocardial septal cryoablation:a canine model with 6-month follow-up[J]. Cryobiology,2024, 116:104933. DOI:10.1016/j.cryobiol.2024.104933.
• [39] C o w g e r J A , B a s i r M B , B a r a n DA, et al. Safety and performance of the aortix device in acute decompensated heart failure and cardiorenal syndrome[J]. JACC Heart Fail,2023, 11(11):1565-1575.DOI:10.1016/j.jchf.2023.06.018.
• [40] Keeble TR, Karamasis GV, Rothman MT, et al. Percutaneous haemodynamic and renal support in patients presenting with decompensated heart failure:a multi-centre e ffi cacy study using the Reitan Catheter Pump(RCP)[J]. Int J Cardiol, 2019,275:53-58.DOI:10.1016/j.ijcard.2018.09.085.
• [41] Lindenfeld J,Costanzo MR,Zile MR,et al. Implantable hemodynamic monitors improve survival in patients with heart failure and reduced ejection fraction[J]. J Am Coll Cardiol,2024,83(6):682-694. DOI:10.1016/j.jacc.2023.11.030.
• [42] Clephas PRD, Radhoe SP, Boersma E, et al. E ffi cacy of pulmonary artery pressure monitoring in patients with chronic heart failure:a meta-analysis of three randomized controlled trials[J]. Eur Heart J, 2023, 44(37):3658-3668. DOI:10.1093/eurheartj/ehad346.
• [43] Guichard JL, Bonno EL, Nassif ME, et al. Seated pulmonary artery pressure monitoring in patients with heart failure:results of the PROACTIVE-HF trial[J]. JACC Heart Fail, 2024, 12(11):1879-1893. DOI:10.1016/j.jchf.2024.05.017.
• [44] D ’ A m a r i o D , M e e r k i n D, Restivo A, et al. Safety,usability, and performance of a wireless left atrial pressure monitoring system in patients with heart failure:the VECTORHF trial[J]. Eur J Heart Fail, 2023, 25(6):902-911.DOI:10.1002/ejhf.2869.
• [45] Meerkin D, Perl L, Hasin T, et al. Physician-directed patient self-management in heart failure using left atrial pressure:Interim insights from the VECTOR-HFⅠandⅡa studies[J]. Eur J Heart Fail, 2024, 26(8):1814-1823. DOI:10.1002/ejhf.3338.
• [46] Girerd N, Barbet V, Seronde MF, et al. Association of a remote monitoring programme with all-cause mortality and hospitalizations in patients with heart failure:national-scale,real-world evidence from a 3-year propensity score analysis of the TELESAT-HF study[J]. Eur J Heart Fail,2025,27(9):1658-1669. DOI:10.1002/ejhf.3563
• [47] Abdin A, Lauder L, Fudim M, et al. Neuromodulation interventions in the management of heart failure[J]. Eur J Heart Fail, 2024, 26(2):502-510. DOI:10.1002/ejhf.3147.
• [48] Pahuja M, Akhtar KH, Krishan S, et al. Neuromodulation therapies in heart failure:a state-of-the-art review[J]. J Soc Cardiovasc Angiogr Interv, 2023, 2(6Part B):101199.DOI:10.1016/j.jscai.2023.101199.
• [49]郭炳辰，唐昊，李光辉，等.慢性心力衰竭神经调节治疗技术的应用与研究进展[J].中国介入心脏病学杂志，2023,31(8):603-608.DOI:10.3969/j.issn.1004-8812.2023.08.007.
• [50] Zile MR, Lindenfeld J, Weaver FA, et al. Barorefl ex activation therapy in patients with heart failure and a reduced ejection fraction:long-term outcomes[J]. Eur J Heart Fail,2024, 26(4):1051-1061. DOI:10.1002/ejhf.3232.
• [51] Fudim M, Borlaug BA, Mohan RC, et al. Endovascular ablation of the greater splanchnic nerve in heart failure with preserved ejection fraction:the REBALANCE-HF randomized clinical trial[J]. JAMA Cardiol, 2024, 9(12):1143-1153.DOI:10.1001/jamacardio.2024.2612.