Right greater splanchnic nerve ablation improved 6-minute walk distance by a mean of 44.65 meters at 6 months compared to baseline, though randomized sham-controlled evidence did not demonstrate a clear comparative benefit.
Meta-Analysis (n=91)
Does endovascular ablation of the right greater splanchnic nerve improve functional and hemodynamic outcomes in patients with heart failure with preserved ejection fraction?
While right greater splanchnic nerve ablation improves functional and hemodynamic outcomes in uncontrolled studies of HFpEF, randomized sham-controlled trials have not yet demonstrated a clear benefit.
Mean Difference: 44.65 (95% CI 12.62–76.68)
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) remains difficult to manage because conventional therapies often provide limited symptom relief and do not adequately address exercise-related congestion. Right greater splanchnic nerve (GSN) ablation has emerged as a potential therapeutic approach by modulating splanchnic venous capacitance. However, current evidence is limited and includes both uncontrolled and randomized studies. METHODS: We performed a systematic review and meta-analysis of studies evaluating right GSN ablation in HFpEF. Searches were conducted in PubMed, Scopus, and Embase in December 2024. Randomized and non-randomized studies were included. Continuous outcomes were pooled as mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses excluding the randomized controlled trial (RCT) were performed for selected outcomes. Analyses based on uncontrolled studies and converted median/interquartile range data were considered exploratory. RESULTS: The most consistent findings were observed in functional and exercise-related hemodynamic outcomes. Six-minute walk distance improved at both 6 and 12 months, and KCCQ overall score showed improvement, although with substantial heterogeneity. Provocative hemodynamic measures, including 20 W and peak pulmonary capillary wedge pressure, were reduced at 1 month, whereas resting hemodynamic measures showed no clear pooled benefit. NT-proBNP, renal indices, blood pressure, heart rate, and left ventricular ejection fraction were largely unchanged. Overall, randomized sham-controlled evidence did not demonstrate a clear comparative benefit. CONCLUSIONS: Right GSN ablation may improve selected exercise-related hemodynamic, functional, and patient-reported outcomes in HFpEF, but the current evidence base is driven mainly by small uncontrolled studies. Randomized evidence remains neutral, and further sham-controlled trials are required.
Manea et al. (Mon,) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=91). Right greater splanchnic nerve ablation vs. Sham procedure or baseline (uncontrolled) was evaluated on 6-minute walk test (6MWT) distance at 6 months (MD 44.65, 95% CI 12.62 to 76.68). Right greater splanchnic nerve ablation improved 6-minute walk distance by a mean of 44.65 meters at 6 months compared to baseline, though randomized sham-controlled evidence did not demonstrate a clear comparative benefit.