Percutaneous Transluminal Caval-Flow Regulation PTCR®: A New Alternative Therapy to Reshape the Future Treatment of Heart Failure

Abstract

Percutaneous Transluminal Caval-flow Regulation (PTCR) is an emerging alternative therapy to treat patients with acute heart failure (AHF). AHF represents the first cause of hospitalization in elderly persons and is the main determinant of the huge healthcare expenditure related to heart failure (HF). Despite therapeutic advances, the prognosis of AHF is poor, with in-hospital mortality ranging from 4% to 7%, 60 to 90-day mortality. To reverse this situation, a balloon catheter medical device has been designed to produce cyclic occlusions of the Inferior Vena Cava (IVC) supported by the phases of respiration, thus having subtotal occlusion during expiration and total occlusion during inspiration, producing an intermittent regulation of venous return or preload from the IVC to the right atrium. This PTCR procedure is minimally invasive. It is performed through the insertion of the balloon catheter via the femoral vein. This catheter is advanced to the IVC guided by echocardiogram or fluoroscopy to be placed prior to drainage of the hepatic vein. At this point, the balloon is inflated up to 70% to 80% of the diameter of the IVC in expiration, which has to be previously evaluated by echocardiography. Then inspiratory collapse (20 to 30% average) of the IVC diameter produces total occlusion during inspiration and a partial or subtotal occlusion during expiration, thereby regulating caval flow in an intermittent manner. This innovative procedure is aimed at regulating the hypervolemia present in the IVC, normalizing venous return, preload, intracardiac pressures, biventricular diastolic and systolic diameters, diastolic and systolic volume, thus, obtaining reduction of total cardiac burden (TCB) and producing a reversal of ventricular remodeling. In this manner the heart returns close to its original design, with improvement in ejection fraction (EF) and cardiac output.