Elevated left atrial (LA) pressure is thought to be the common final pathological way in decompensated heart failure (HF). We aimed to gather currently available clinical evidence to evaluate the feasibility of inter-atrial shunt devices in HF patients.

We searched PubMed and Cochrane Library databases through 23rd April 23, 2016. Data were extracted by two investigators independently. We pooled outcomes of interest in Revman 5.2 (The Cochrane Collaboration, Oxford, United Kingdom).

A total of four records were identified in the final review, involving HF patients with reduced ejection fraction (EF) and those with preserved EF. Pooled analysis showed that pulmonary capillary wedge pressure significantly reduced after inter-atrial shunt devices implantation, with a mean difference (MD) of −3.54mmHg (95% confidence interval [CI]=−5.63 to −1.45mmHg) and low heterogeneity (I²=16%), 6-minute walk distance significantly increased, with a MD of 36.84m (95% CI=3.52 to 70.16m) and low heterogeneity (I²=0%), and Minnesota Living with Heart Failure score significantly improved (MD=−22.99 with 95% CI −44.45 to −1.52) following shunting. No evidence of worsening pulmonary hypertension was observed in these studies. No device-related deaths, thrombo-embolic or cardiac events were recorded during follow-up.

Current evidence suggests that inter-atrial shunting might be a potential and promising therapy for HF, regardless of the ejection fraction.