Direct Interstitial Decongestion in an Animal Model of Acute-on-Chronic Ischemic Heart Failure

William T Abraham; Michael Jonas; Ranjeet M Dongaonkar; Beth Geist; Yukie Ueyama; Kevin Render; Brad Youngblood; William Muir; Robert Hamlin; Carlos L Del Rio

doi:10.1016/j.jacbts.2021.09.008

Direct Interstitial Decongestion in an Animal Model of Acute-on-Chronic Ischemic Heart Failure

JACC Basic Transl Sci. 2021 Nov 22;6(11):872-881. doi: 10.1016/j.jacbts.2021.09.008. eCollection 2021 Nov.

Authors

William T Abraham¹, Michael Jonas², Ranjeet M Dongaonkar³, Beth Geist⁴, Yukie Ueyama⁴, Kevin Render⁴, Brad Youngblood⁴, William Muir⁴, Robert Hamlin^{1

4}, Carlos L Del Rio^{4

5}

Affiliations

¹ Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA.
² Department of Cardiology, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel.
³ Department of Veterinary Physiology & Pharmacology, Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, Texas, USA.
⁴ QTest Labs, Columbus, Ohio, USA.
⁵ Cardiac Consulting, San Mateo, California, USA.

Abstract

Removal of excess fluid in acute decompensated heart failure (ADHF) targets the intravascular space, whereas most fluid resides in the interstitial space. The authors evaluated an approach to interstitial decongestion using a device to enhance lymph flow. The device was deployed in sheep with induced heart failure (HF) and acute volume overload to create a low-pressure zone at the thoracic duct outlet. Treatment decreased extravascular lung water (EVLW) volume (mL/kg) (-32% ± 9%, P = 0.029) compared to controls (+46% ± 9%, P = 0.003). Device-mediated thoracic duct decompression effectively reduced EVLW. Human studies may establish device-based interstitial decongestion as a new ADHF treatment.

Keywords: ADHF, acute decompensated heart failure; CVP, central venous pressure; EVLW, extravascular lung water; acute decompensated heart failure; decongestion; interstitial; lymphatic; pulmonary edema; thoracic duct; volume overload.