Surgical ablation of the right greater splanchnic nerve for the treatment of heart failure with preserved ejection fraction: first‐in‐human clinical trial. (16th July 2021)

• Record Type: Journal Article
• Authors: Málek, Filip; Gajewski, Piotr; Zymliński, Robert; Janczak, Dariusz; Chabowski, Mariusz; Fudim, Marat; Martinca, Tomas; Neužil, Petr; Biegus, Jan; Mates, Martin; Krüger, Andreas; Skalský, Ivo; Bapna, Anisha; Engelman, Zoar J.; Ponikowski, Piotr P.
• Is Part Of: European journal of heart failure. Volume 23:Number 7(2021)
• Page Start: 1134
• Page End: 1143
• Publication Date: 2021-07-16
• Subjects: Heart failure -- Heart failure with preserved ejection fraction -- Greater splanchnic nerve ablation; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2209
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract: Aims: Inappropriate control of blood volume redistribution may be a mechanism responsible for exercise intolerance in heart failure with preserved ejection fraction (HFpEF). We propose to address this underlying pathophysiology with selective blockade of sympathetic signalling to the splanchnic circulation by surgical ablation of the right greater splanchnic nerve (GSN). Methods and results: In a single‐arm, prospective, two‐centre trial, 10 patients with HFpEF (50% male, mean age 70 ± 3 years) all with New York Heart Association (NYHA) class III, left ventricular ejection fraction >40%, pulmonary capillary wedge pressure (PCWP) ≥15 mmHg at rest or ≥25 mmHg with supine cycle ergometry, underwent ablation of the right GSN via thoracoscopic surgery. Patients were evaluated at baseline, 1, 3, 6 and 12 months after the procedure. The primary endpoint was a reduction in exercise PCWP at 3 months. There were no adverse events related to the blockade of the nerve during 12‐month follow‐up but three patients had significant peri‐procedural adverse events related to the surgical procedure itself. At 3 months post‐GSN ablation, patients demonstrated a reduction in 20 W exercise PCWP when compared to baseline [−4.5 mmHg (95% confidence interval, CI −14 to −2); P = 0.0059], which carried over to peak exercise [−5 mmHg (95% CI −11 to 0; P = 0.016). At 12 months, improvements were seen in NYHA class [3 (3) vs. 2 (1, 2); P = 0.0039] and quality of life assessed with the Minnesota Living with Heart Failure Questionnaire [60 (51, 71) vs. 22 (16, 27); P = 0.0039]. Conclusion: In this first‐in‐human study, GSN ablation in HFpEF proved to be feasible, with a suggestion of reduced cardiac filling pressure during exercise, improved quality of life and exercise capacity. Abstract : Concept and results for the study of splanchnic nerve modulation in heart failure with preserved ejection fraction.