World Cardiology Conference 2026

Abstract

Introduction:Pressure toxicity is the primary driver of Heart Failure (HF) progression, triggering adverse ventricular remodeling and end-organ dysfunction. Despite standard-of-care medical therapy, diuretic resistance remains a critical barrier, leading to high 90-day readmission rates. We present the Percutaneous Transluminal Caval-flow Regulation (PTCR®), a novel mechanical therapy designed to break the congestion cycle by "metering" venous return, allowing for effective cardiac offloading independent of renal function.
Methods:The PTCR system utilizes a high-compliance polyurethane balloon catheter positioned in the Inferior Vena Cava (IVC), proximal to the hepatic veins. The device leverages the patient's intrinsic respiratory dynamics to achieve intermittent occlusion: partial flow restriction during expiration and transient total occlusion during inspiration (capitalizing on the physiological collapse of the IVC). The hemodynamic impact was evaluated in a cohort of patients ($N=6$) with acute decompensated HF and refractory congestion via Right Heart Catheterization (RHC).Results and Clinical Benefits in HF:Activation of the PTCR system resulted in immediate and sustained hemodynamic decompression, demonstrating the following clinical advantages:

 Acute Cardiac Offloading: Mean Right Atrial Pressure (mRAP) decreased by 42.59% ($P=0.005$) and Mean Pulmonary Capillary Wedge Pressure (mPCWP) dropped by     31.37% ($P=0.016$), providing instant relief from systemic and pulmonary congestion. Positive Reverse Remodeling: A 14.4% reduction in Left Ventricular End-Diastolic    Volume (LVEDV) was observed within 30 minutes of activation. Optimization of Systolic Function: The Ejection Fraction (EF) increased by an average of 21.9%,           confirming that by modulating preload, the overloaded ventricle operates at a more efficient point on the Frank-Starling curve. Cardiorenal Protection: By lowering mRAP, t  he device restores the renal perfusion gradient, potentially reversing congestive nephropathy by reducing the "afterload" of the nephron.

Conclusion:The PTCR® system offers a dynamic, extracardiac solution that overcomes the limitations of traditional pharmacological diuresis. By synchronizing with the patient’s own respiratory cycle, it achieves a physiological regulation that reduces the Total Cardiac Burden (TCB), improves ventricular efficiency, and provides a vital therapeutic pathway for patients with refractory HF or those in whom aggressive drug therapy is contraindicated.