Endovascular ablation of the right greater splanchnic nerve for the management of heart failure with preserved ejection fraction: a systematic review and meta-analysis.
Hashim Manea, Mostafa A Khalifa, Mustafa A Shahrori, Aya Ahmed Shimal, Ahmad Omar Saleh, Omnia Samy El-Sayed, Muhammad Bashir, Elian Khalafalla Awadalla, Alaa R Al-Ihribat, Fathimathul Henna, Mohammedbaqer Al-Ghuraibawi, Mohammad Amjad Shahrori
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Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) remains difficult to manage because conventional therapies often provide limited symptom relief and do not adequately address exercise-related congestion. Right greater splanchnic nerve (GSN) ablation has emerged as a potential therapeutic approach by modulating splanchnic venous capacitance. However, current evidence is limited and includes both uncontrolled and randomized studies.
Methods: We performed a systematic review and meta-analysis of studies evaluating right GSN ablation in HFpEF. Searches were conducted in PubMed, Scopus, and Embase in December 2024. Randomized and non-randomized studies were included. Continuous outcomes were pooled as mean differences (MDs) with 95% confidence intervals (CIs). Sensitivity analyses excluding the randomized controlled trial (RCT) were performed for selected outcomes. Analyses based on uncontrolled studies and converted median/interquartile range data were considered exploratory.
Results: The most consistent findings were observed in functional and exercise-related hemodynamic outcomes. Six-minute walk distance improved at both 6 and 12 months, and KCCQ overall score showed improvement, although with substantial heterogeneity. Provocative hemodynamic measures, including 20 W and peak pulmonary capillary wedge pressure, were reduced at 1 month, whereas resting hemodynamic measures showed no clear pooled benefit. NT-proBNP, renal indices, blood pressure, heart rate, and left ventricular ejection fraction were largely unchanged. Overall, randomized sham-controlled evidence did not demonstrate a clear comparative benefit.
Conclusions: Right GSN ablation may improve selected exercise-related hemodynamic, functional, and patient-reported outcomes in HFpEF, but the current evidence base is driven mainly by small uncontrolled studies. Randomized evidence remains neutral, and further sham-controlled trials are required.
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