Early Feasibility Study - Edwards APTURE Transcatheter Shunt System

Inclusion Criteria: * Symptomatic Heart Failure (HF): * NYHA class II with a history of \> II; III; or ambulatory IV AND * ≥ 1 HF hospital admission; or treatment with IV or oral diuresis within 12 months; OR an NT-pro BNP value \> 150 pg./ml in normal sinus rhythm, \> 450 pg./ml in atrial fibrillation, or a BNP value \> 50 pg./ml in normal sinus rhythm, \> 150 pg./ml in atrial fibrillation within the past 6 months prior to study entry. * On stable Guideline Directed Medical Therapy (GDMT) for heart failure * At rest: elevated LAP (or PCWP) of \> 15 mmHg and LAP (or PCWP) exceeds right atrial pressure (RAP) by \> 5 mmHg AND/OR supine ergometer exercise, elevated LA (or PCWP) pressure of \> 25 mmHg and LA (or PCWP) exceeds right atrial pressure (RAP) by \> 10 mmHg * Left Ventricular Ejection Fraction (LVEF) ≤ 40% * Pulmonary Vascular Resistance (PVR) \< 4.0 WU Exclusion Criteria: * Severe HF: * Stage D, non-ambulatory NYHA Class IV, transplant list * If BMI \< 30, Cardiac index \< 2.0 L/min/m2 * If BMI ≥ 30, cardiac index \< 1.8 L/min/m2 * Left Ventricular End-Diastolic Diameter (LVEDD) \> 8 cm * LVEF \< 20% * Valve disease: MR \> 3+ or \> moderate MS, TR \> 2+, AR \> 2+ or \> moderate AS * MI or therapeutic invasive cardiac procedure \< 3 months * TIA, stroke, CRT implanted \< 6 months * RV dysfunction \> mild by TTE OR TAPSE \< 1.2 OR RV size ≥ LV size by TTE, OR right ventricular fractional area change (RVFAC) ≤ 25% * Dialysis OR renal dysfunction (S-CR \> 2.5 mg/dl OR eGFR \< 25 ml/min/1.73m2) * 6MWT \< 50m OR \> 600m * Active endocarditis or infection \< 3 months * Mean Right Atrial Pressure (mRAP) \> 15 mmHg at rest * Body Mass Index (BMI) ≥ 45 kg/m2