Rivet PVS Therapy in Group 2 PH-HFpEF Canada

Select Inclusion Criteria: * Age ≥ 18 years * Prior diagnosis of Group 2 PH due to HFpEF, with at least one of the following resting hemodynamic criteria confirmed in the past year by right heart catheterization 1. mPAP \> 20 mmHg at rest 2. mPAP/CO slope \> 3 mmHg/L/min with exercise * Confirmation of the following hemodynamic criteria during supine exercise: PCWP ≥ 25 mmHg, or PCWP/CO slope \> 2 mmHg/L/min * Chronic symptomatic heart failure documented by the following: 1. NYHA HF Class II with history \> II, or Class III, or ambulatory Class IV 2. ≥ 1 HF hospitalization, or healthcare facility with IV diuretics or intensification of oral diuresis for HF within 12 months, or NT-pro BNP value \> 400 pg/mL in normal sinus rhythm or \> 750 pg/mL in atrial fibrillation in past 6 months * Ongoing stable guideline directed medical therapy (GDMT) for HF and medically optimized per treating cardiologist according to current ACCF/AHA guidelines that is expected to be maintained without change for 1 month (excluding diuretic dosage changes for HF optimization within 30 days of the Index Procedure) * 6MWD ≥ 100 m Select Exclusion Criteria: * Any therapeutic intracardiac intervention within the last 30 days * PH Group 1, 3, 4 or 5 * Mean RAP \>16 mmHg by RHC at rest on room air * Right ventricular dysfunction, defined as one or more of the following 1. Greater than moderate RV dysfunction as assessed by TTE and/or MRI 2. RV FAC \< 35% 3. TAPSE \< 14 mm via TTE 4. RV size severely enlarged compared to LV size as estimated by TTE and/or MRI * Severe tricuspid valve regurgitation * Peak systolic pulmonary arterial pressure \> 80 mmHg by RHC at rest while awake * Mean pulmonary arterial pressure \> 50 mmHg by RHC at rest while awake * PVR \> 6 Wood units at rest while awake on room air * Left ventricular ejection fraction \< 50% * Severe heart failure, defined as one or more of the following: 1. ACC/AHA/ESC Stage D heart failure, non-ambulatory NYHA Class IV HF 2. If BMI \< 30, Cardiac Index \< 2.0 L/min/m2 3. If BMI ≥ 30, Cardiac Index \< 1.8 L/min/m2 4. Requires continuous intravenous inotropic infusion 5. Requires mechanical circulatory support 6. Currently on the cardiac transplant waiting list * Chronic renal dysfunction defined as: eGFR \< 35 mL/min/1.73 m2 by the CKD-Epi equation * Chronic pulmonary disease defined as one or more of the following: 1. Requires continuous home oxygen therapy 2. Recent hospitalization for exacerbation within 12 months prior to screening 3. FEV1 \< 50% predicted