DELTA-HF: thoracale-duct lymfedecongestie via eLym-systeem haalbaar bij acute hartfalen

Background: Persistent congestion at discharge is associated with worse outcomes in acute decompensated heart failure (ADHF), with impaired lymphatic function contributing to difficult-to-target tissue and organ congestion. Methods: The safety and effectiveness of the eLym System in ADHF was evaluated in the multicenter, single-arm DELTA-HF trial. A localized reduced-pressure zone at the venous angle was created in 40 patients using an endovenous axial pump to support lymph drainage through the thoracic duct. Results: Forty patients with ADHF (32.5% female, 71±11 years) received therapy. Patients had a median of 2 hospitalizations in the prior 6 months and were on home daily loop diuretic dose equivalent to ≥80 mg furosemide. Device deployment was successful in all cases (therapy time: 23.1±7.3 hours). Weight decreased by 3.6±2.4 kg during eLym therapy and by 6.8±3.4 kg at discharge. Median modified EVEREST Clinical Congestion Score improved from 5.0 to 2.0 after treatment and to 0 by discharge, remaining stable through 6 months (p<0.0001). Serum creatinine remained stable acutely and through 6 months. Freedom from device- or procedure-related serious adverse events was 95%. One patient had a vascular complication causing mediastinal hematoma and death; another required inotropes due to hypotension. At 6 months, two patients experienced three HF hospitalizations and five patients died (four cardiovascular, one urosepsis). Conclusions: eLym therapy in ADHF appeared to be safe, with early data suggesting effective, durable decongestion and a low 6-month rehospitalization rate. Randomized controlled trials are warranted.