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2/ Why the Lymphatic System? HF leads to fluid overload – not just in blood vessels but also in interstitial spaces. The lymphatic system helps clear excess fluid, but in HF, it's overwhelmed and dysfunctional. Could TD drainage offer direct relief? 🤔💧

3/ How Does TD Drainage Work? The thoracic duct (TD) is the body's main lymphatic highway, emptying into the venous system. Draining lymph from the TD could bypass congestion, lower venous pressures, and enhance decongestion.

4/ The Study 📍 Conducted at Duke & Sanatorio Italiano 👥 4 HF patients (NYHA II-IV) 🩻 TD access: Brachial, cervical, or abdominal approach ⏳ Lymph drained for up to 3 hrs 🫀 Hemodynamics measured via right heart cath

5/ Key Findings ✅ TD drainage was feasible in all 4 patients 📉 Mean right atrial pressure ↓ by 4 mmHg 📉 PCWP ↓ by 1.5 mmHg 💦 Lymph output: 230-600 mL over 3 hrs 💧 Urine output ↑ (1 patient: 4.2L in 24 hrs vs. 1L before!)

6/ Safety? 🛑 No major adverse events at 30 days ⚠️ 1 minor AE (transient abdominal pain from access site) 💡 Suggests TD drainage is well-tolerated but needs larger studies

7/ Why Does This Matter? 💊 Diuretics work by reducing intravascular volume but don’t directly address lymphatic congestion 🚫 Diuretic resistance is a huge challenge in HF ⚙️ TD drainage offers a mechanical approach to decongestion

🔥 Science Alert! REBALANCE-HF assessed permanent ablation of the right greater splanchnic nerve in HFpEF. In this sub-study, the authors found that permanent GSN ablation reduced stressed blood volume, thus reducing RAP & PCWP. #THT2025 🔗 bit.ly/4hXV75Q

Looking for an up-to-date overview on Renal Denervation? Read the latest meta-analysis on #EHJOpen! #OpenUpYourScience! European Society of Cardiology Journals Magnus Bäck Salvatore De Rosa Gianluigi Savarese