Lymphatic Drainage in Patients with Heart Failure: A Feasibility Study.

Lymphatic dysfunction contributes to congestion and end-organ damage in heart failure (HF), yet current therapies do not directly target lymphatic congestion. Thoracic duct (TD) drainage offers a novel approach to address this gap. This multicenter feasibility study evaluated the safety and feasibility of minimally invasive TD drainage in patients with HF. Four patients with New York Heart Association class II-IV HF and fluid overload underwent fluoroscopy-guided TD access via cervical, abdominal, or transvenous brachial approaches. Lymph was drained by gravity for up to 3 hours, and hemodynamic changes were measured. TD drainage was successful in all patients, with a mean lymph output of 430 mL. Mean reductions in right atrial and pulmonary capillary wedge pressures were 4 mmHg and 1.5 mmHg, respectively. No major adverse events occurred. TD drainage appears feasible and safe, with potential decongestive benefits. Larger studies are needed to confirm its role in HF management.