{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:31:22Z","timestamp":1781659882160,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Left atrial-to-coronary sinus (LA-to-CS) shunting through the APTURE transcatheter shunt system aims to unload the LA while preserving the interatrial septum. This article aims to examine the 3-year health status, functional capacity, and clinical outcomes of the ALT-FLOW Early Feasibility Study (EFS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Device safety, patency, and echocardiographic parameters, but also symptoms, health status, and exercise capacity were assessed in patients with left ventricular ejection fraction (LVEF) &amp;gt; 40% (n &amp; 95). Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score predicted 3-year all-cause mortality was compared with observed mortality assessed by Kaplan\u2013Meier analysis using adjudicated events. Predicted and observed HF hospitalization (HFH)-free survival rates were also compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 3 years, the safety profile remained stable with no new safety signals, and all implanted shunts remained patent. 76.3% of patients improved by at least one NYHA class, and mean KCCQ Overall Summary Scores increased by 25 points from baseline (P &amp;lt; .0001). The 6-min walk distance improved by an average of 39 m (P &amp; .002). These benefits were consistent regardless of baseline pulmonary vascular resistance (PVR). Right heart echocardiographic parameters after 3 years were stable, though a reduction in TAPSE was observed, primarily in the high PVR subgroup. The observed 3-year survival was significantly higher than the MAGGIC-predicted survival (84.4% vs 70.2, respectively; P &amp; .009), as well as the HFH-free survival (68.0% vs 24.0%, respectively; P &amp;lt; 0001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with HF and LVEF &amp;gt;40%, the APTURE LA-to-CS shunting confirmed an acceptable safety profile with stable right heart parameters and sustained improvements in symptoms, quality of life, and functional capacity at 3 years. Observed survival and HFH were superior to MAGGIC predictions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag070","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T12:39:09Z","timestamp":1772800749000},"source":"Crossref","is-referenced-by-count":1,"title":["The ALT FLOW early feasibility study 3-year results assessing left atrial to coronary sinus shunting in HFpEF"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7174-8604","authenticated-orcid":false,"given":"Francesco","family":"Fioretti","sequence":"first","affiliation":[{"name":"From the Baylor Scott & White Research Institute , 3434 Live Oak St Ste 501, Dallas, TX 75204 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0906-1363","authenticated-orcid":false,"given":"Benjamin","family":"Hibbert","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular 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