Clinical Evaluation of the TRVD™ System in ADHF (TRVD)

This is an interventional treatment trial for Acute Heart Failure Read More

Inclusion Criteria:

1. Patient is 18 years of age or older
2. Patient admitted to the hospital with a primary diagnosis of ADHF who is chronically treated with at least one oral loop diuretic.
3. Patient presents at least two of the following clinical signs of manifest volume overload: 3.1 Jugular venous distension 3.2 Dyspnea, rales, or evidence of pulmonary congestion or oedema on admission chest radiography 3.3 Abdominal discomfort compatible with internal organ congestion and/or hepatomegaly 3.4 Peripheral oedema
4. Ultrasonic evidence of IVC plethora, defined as IVC diameter >2.0 cm.
5. BNP levels >300 pg/dL or NT-proBNP >1500 pg/dL .
6. Evidence of cardiac etiology as per cardiac ultrasonography.
7. LVEF =/<40%.
8. CVP (Invasively measured) >/=14 mmHg
9. Male or non-pregnant / non-lactating female (NOTE: Females of child bearing potential must have a negative pregnancy test).
10. Patient understands the nature of the procedure and provides written informed consent prior to any study specific assessments.

Exclusion Criteria:

1. INR >3, use of a NOAC in the past 48 hours or contraindication to systemic anticoagulation with Heparin.
2. Evidence of hemodynamic instability, evidence of shock with organ hypoperfusion, or need for inotropic support.
3. Overt pulmonary oedema, or Respiratory insufficiency/hypoxia (peripheral haemoglobin saturation <90% with supplemental oxygen), need for non-invasive positive pressure ventilation or intubation.
4. Severe renal dysfunction (eGFR before decompensation <45 ml/min/1.73 m2 BSA or <25 on admission).
5. Known renal artery stenosis.
6. Known intrinsic kidney disease (e.g., established diagnosis of diabetic nephropathy with macroproteinuria, chronic glomerulonephritis).
7. Severe anaemia (haemoglobin <9 mg/dL).
8. Thrombocytopenia with a platelets count <100,000.
9. Acute coronary syndrome within 4 weeks prior to admission.
10. Active myocarditis or hypertrophic obstructive cardiomyopathy.
11. Complex congenital heart disease.
12. Severe valvular stenosis.
13. Severe morbid obesity (BMI >35).
14. Fluid retention that is not primarily of cardiac origin (e.g., advanced liver disease, severe hypo-albuminaemia, etc.)
15. Temperature > 38°C (oral or equivalent), or sepsis, or active systemic infection requiring IV anti-microbial treatment.
16. Large ascites per ultrasound/CT.
17. Cognitive impairment.
18. Planned PCI, or more than minor surgery in the next 3 months.
19. Moribund patient, or patient with malignancy or other comorbidities limiting life expectancy to less than one year.
20. Patient has a known allergy to Nickel.
21. Contraindication to recommended study medications or intravascular contrast material that cannot be adequately controlled with pre-medication.
22. Concurrent enrollment in another device or drug trial that has not completed the primary endpoint or clinically interferes with the current study endpoints.