Superior Vena Caval Occlusion in Acute Decompensated Heart Failure: First-in-Human Experience

Background
Elevated cardiac filling pressures are associated with poor outcomes in heart failure. In a single-center first-in-man proof of concept study, we tested the hypothesis that transient occlusion of the superior vena cava (SVC) reduces cardiac filling pressures without reducing cardiac output or systemic blood pressure.

Methods
Patients admitted with systolic heart failure and volume overload were included. A 32cc balloon was used to occlude the SVC for 5 or 10 minutes (Figure 1A). Patients underwent neurologic testing before, during and after SVC occlusion with repeat testing within 10 minutes of balloon release, and after 1, 3, and 24 hours.

Results
Eight patients were enrolled. SVC occlusion was successfully performed in all patients. Right internal jugular venous pressure rose during SVC occlusion and returned to baseline values after release. Compared to baseline, 5 minutes of SVC occlusion significantly reduced right atrial pressure, pulmonary pressures, and pulmonary capillary wedge pressure without changing systemic mean arterial pressure or cardiac output (Figure 1B-C). In the last 3 patients, a second SVC occlusion was performed for 10 minutes with similar hemodynamic findings. Neurologic testing was unchanged compared to baseline values for all patients. All patients at 7- and 30-days were alive without stroke, heart attack, SVC injury or thrombosis, or unanticipated surgery.

Conclusions
We report the first-in-man experience with SVC occlusion as a potentially novel approach to rapidly and significantly reduce cardiac filling pressures in heart failure.