May 21, 2019Open Access
First‐in‐human experience with occlusion of the superior vena cava to reduce cardiac filling pressures in congestive heart failure
Structured PICO
Does transient occlusion of the superior vena cava safely reduce cardiac filling pressures in patients with acutely decompensated systolic heart failure?
P
Population
8 patients with acutely decompensated systolic heart failure and reduced ejection fraction
I
Intervention
Transient occlusion of the superior vena cava (SVC) using a commercially available occlusion balloon for 5 minutes (with a second 10-minute occlusion in 3 patients)
O
Outcome
Safety and feasibility (reduction of biventricular filling pressures without decreasing systemic blood pressure or total cardiac output, and absence of adverse events at 7 days)safety
Transient SVC occlusion is a feasible and safe novel approach to rapidly reduce biventricular filling pressures without compromising cardiac output in patients with acutely decompensated heart failure.
Abstract
BACKGROUND: Acutely decompensated heart failure remains a major clinical problem. Volume overload promotes cardiac and renal dysfunction and is associated with increased morbidity and mortality in heart failure. We hypothesized that transient occlusion of the superior vena cava (SVC) will reduce cardiac filling pressures without reducing cardiac output or systemic blood pressure. The objective of this proof of concept study was to provide initial evidence of safety and feasibility of transient SVC occlusion in patients with acutely decompensated heart failure and reduced ejection fraction. METHODS AND RESULTS: In eight patients with systolic heart failure, SVC occlusion was performed using a commercially available occlusion balloon. Five minutes of SVC occlusion reduced biventricular filling pressures without decreasing systemic blood pressure or total cardiac output. In three of the eight patients, a second 10-minutes occlusion had similar hemodynamic effects. SVC occlusion was well-tolerated without development of new symptoms, new neurologic deficits, or any adverse events including stroke, heart attack, or reported SVC injury or thrombosis at 7 days of follow up. CONCLUSION: We report the first clinical experience with transient SVC occlusion as a potentially new therapeutic approach to rapidly reduce cardiac filling pressures in heart failure. No prohibitive safety signal was identified and further testing to establish the clinical utility of transient SVC occlusion for acute decompensated heart failure is justified.