The Prelieve Trial - Pilot Study to Assess Safety and Efficacy of a Novel Atrial Flow Regulator (AFR) in Heart Failure Patients

Inclusion criteria. Each patient must fulfill ALL of the following criteria and details: 1. Age ≥18 years 2. Heart failure resulting in NYHA class III or IV ambulatory 3. Ongoing management of heart failure according to ESC (European Society of Cardiology) (15) -guidelines during previous ≥6 months 4. Control with Arrhythmia with heart rate \<110bpm 5. Life expectancy of at least 1 year 6. The patient should have the ability to fluently speak and understand the language in which the study is being conducted 7. Written, informed consent by the patient for participation in the study and agreement to comply with the follow-up schedule 8. Patient has had a successful Balloon Atrial Septostomy (BAS) procedure and is in a stable hemodynamic state, as assessed by the investigator 9. LVEF ≥15% and ≤ 70% , EF measured via Echocardiography 9.1.9.1. And for LVEF ≥ 40% (HFpEF): elevated NT-pro-BNP of ≥ 125 pg/ml 10. Elevated left ventricular filling pressure documented by 10.1. Either Pulmonary capillary wedge pressure (PCWP) or left ventricular end-diastolic pressure at rest ≥ 15 mmHg and greater then central venous preassure (CVP) 10.2. 10.2. Or: End-expiratory PCWP ≥25 mmHg at exercise and CVP \<20 mm Hg 11. Transseptal catheterization and femoral vein access is determined to be feasible Exclusion Criteria: 1. Local or generalized sepsis or other acute infection(s) 2. Any coagulation disorder, if clinically relevant in the opinion of the operator. 3. Allergy to nickel and/or titanium and/or nickel/titanium-based materials, if not medically manageable 4. Allergy to anti-platelet, -coagulant, or -thrombotic therapy, if not medically manageable 5. Intolerance to contrast agents, if not medically manageable 6. Participation in another medical trial testing a therapy less than 30 days before the intended AFR implantation procedure 7. Trans-oesophageal echocardiography and / or use of general anaesthetic is contraindicated 8. Breast feeding women 9. Pregnancy Processes which would technically disturb the safe intervention as planned: 10. Occluded inferior vena cava access 11. History of ASD and/or atrial septal repair or closure device in place 12. Intracardiac thrombus Clinical conditions: 13. Moderate valvular diseases requiring therapy according to current ESC guidelines. Patients are eligible in case therapy is formally indicated but cannot be performed due to technical or medial reasons if the latter is confirmed in writing by the PI in mutual agreement with the heart team and Severe aortic stenosis with valve area \< 1.5cm² and Severe AR, TR or MR. Classification of severity of regurgitation should follow the definition provided in Lancelotti et al, Eur Heart J Cardiovasc Imaging 2013 \[22\] 14. Patients who has unstable and intractable angina pectoris 15. Evidence of right heart failure defined as (by ECHO) 1. Severe Right Ventricular Dysfunction (TAPSE \< 14 mm) 2. Severe Right Ventricular Dilatation (RV volume ≥ LV volume) 3. Severe pulmonary hypertension (PASP \> 60 mm Hg) 16. Active malignancy 17. Severe valve disease, or implanted mechanical valve prosthesis 18. Congenital heart defect 19. Large PFO with significant atrial septal aneurysm (bubble test shows more than 20 bubbles) 20. Inability to perform 6-minutes walking test 21. Clinically relevant thrombocytopenia, thrombocytosis, leukopenia, or anemia 22. Symptomatic carotid artery disease 23. Mitral valve stenosis 24. Has any condition that, in the opinion of the Investigator, might interfere with the Implantation, might affect the patients well-being thereafter or might interfere with the conduct of the study 25. Systolic blood pressure of \>170 mmHg, despite medical therapy 26. Severe lung disease (causing PHT with systolic PAP \>60mmHg) 27. Pulmonary Hypertension (Systolic PAP \>60mmHg) 28. TIA or stroke within the last 6 months 29. Scheduled for heart transplantation 30. Bleeding disorders (INR \> 2.0, Thrombocytes \< 100.000, Hemoglobin \<8.0 gr/dl) 31. Myocardial infarction or percutaneous intervention or CABG (all within the last 3 month) or indication for a coronary intervention 32. Resyncronization therapy started within the last 6 months 33. Aneurysm of the septum 34. Hypertrophied Inter Atrial Septum (IAS) \> 10mm depth 35. Hypertrophic Obstructive Cardiomyopathy (HOCM) or infiltrative CM as cause of HF 36. Thromboembolic events within the last 6 months 37. Dialysis and renal insufficiency requiring dialysis