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

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

William T Abraham  1 , Michael Jonas  2 , Ranjeet M Dongaonkar  3 , Beth Geist  4 , Yukie Ueyama  4 , Kevin Render  4 , Brad Youngblood  4 , William Muir  4 , Robert Hamlin  1   4 , Carlos L Del Rio  4   5
Affiliations

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

William T Abraham et al. JACC Basic Transl Sci. .

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.

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Conflict of interest statement

WhiteSwell funded the studies. Drs Abraham, Jonas, and Dongaonkar have received consulting fees from WhiteSwell. Drs Geist, Ueyama, Render, Youngblood, Muir, Hamlin, and del Rio have received research fees from WhiteSwell for the conduct of the animal studies.

Figures

None
Graphical abstract
Figure 1
Figure 1
First-Generation Whiteswell Catheter See text for description.
Figure 2
Figure 2
Extravascular Lung Water Changes (Top) Changes in the estimated extravascular lung water content (EVLW) as measured in sheep with induced acute decompensation (ADHF) both before and during treatment with the WhiteSwell device (left). Changes in time-matched untreated controls (CTRL) are shown (right) for comparison. (Bottom) Absolute and/or relative changes post-treatment in EVLW (mL/kg), arterial oxygen tension (PaO2), left-ventricular filling pressures (EDP), and cardiac output (CO).
Figure 3
Figure 3
Clinical Case Example With Whiteswell Treatment During WhiteSwell treatment, urine output increased (yellow). Comparing post-therapy to pretreatment, the central venous pressure decreased from 17 mm Hg to 3 mm Hg, and creatinine levels fell slightly (blue dots).
Figure 4
Figure 4
Lymphatic System and Thoracic Duct Function in Healthy Individuals and in Acute Decompensated Heart Failure (A and B) Normal thoracic duct function and lymph formation. (C and D) Pathological changes in thoracic duct function and lymph formation in the setting of acute decompensated heart failure (ADHF). (E) Thoracic duct decompression and restoration of lymph flow during treatment with the WhiteSwell device. See text for detailed explanations. Figure by Avesta Rastan.
See this image and copyright information in PMC

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