Device-driven cyclic compression of the superior vena cava as a preload reduction strategy to improve cardiac function in heart failure

Device-driven cyclic compression of the superior vena cava as a preload reduction strategy to improve cardiac function in heart failure | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Device-driven cyclic compression of the superior vena cava as a preload reduction strategy to improve cardiac function in heart failure Jeongwon Kim, Yongjin Kim, Jeonghyeon Lee, Domin Cho, Chang Jun Lee, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7502207/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 14 You are reading this latest preprint version Abstract We evaluated the physiological efficacy and safety of a novel device-based preload reduction strategy that applies external cyclic compression to the superior vena cava (SVC) in a preclinical heart failure model. Heart failure was induced in eleven pigs using ischemia–reperfusion injury, and a 3D-printed SVC compression device was tested under varying compression ratios and protocols. Hemodynamic responses were monitored using right-heart catheterization and pressure–volume loop analysis. Among the tested conditions, cyclic compression at 85% with 20/5-minute compression–release cycles produced the most favorable effects. Cardiac output increased by 27.3% (3.83 to 4.88 L/min, p = 0.008) and stroke volume by 19.5% (38.6 to 46.1 mL, p = 0.006), while mean arterial and pulmonary pressures remained stable. Systemic vascular resistance decreased by 29.0% (1,200 to 852 dyn·s/cm⁵, p = 0.011), accompanied by reductions in left ventricular end-diastolic pressures and improved contractility. These results demonstrate that externally applied cyclic SVC compression effectively reduces preload and augments cardiac performance without compromising hemodynamic stability. Our study provides a proof-of-concept for the clinical utility of a device-driven external cyclic compression of the SVC as an adjunctive therapy for acute decompensated heart failure, especially in perioperative or critical care settings, and supports further development toward an implantable clinical system. Health sciences/Cardiology Health sciences/Medical research Biological sciences/Physiology Heart failure Preload Vena cava Hemodynamics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Heart failure is one of the leading causes of morbidity and mortality worldwide 1 , and the burden of this disease continues to increase despite advancements in clinical practice guidelines and various therapies, which are primarily pharmacological 2 . A significant change in the pathophysiology of heart failure is the increase in cardiac preload and ventricular workload, which occurs due to decreased ventricular contractility and impaired systolic function. As the Frank-Starling mechanism becomes less effective in cases of reduced ventricular function 3,4 , additional preload fails to enhance cardiac output; instead, it leads to myocardial strain and diminished ventricular efficiency, resulting in harmful ventricular remodeling and subsequent pulmonary and systemic congestion 5–7 . Considering this pathophysiology, reducing preload has become a crucial component of therapeutic strategies for managing heart failure. Currently used medications, such as diuretics and vasodilators, are effective in reducing preload; however, they are often insufficient in advanced heart failure and have several limitations, including decreased renal function, hypotension, and the development of tolerance with long-term use. Various interventional approaches have also been explored, including endovascular occlusion of the superior vena cava (SVC) to mechanically reduce venous return 8–10 , transient inferior vena cava (IVC) flow regulation using a catheter 11,12 , and splanchnic nerve blockade to redistribute blood volume into the abdominal compartment 13–15 . However, both SVC and IVC occlusion techniques involve intravascular catheterization, which may necessitate anticoagulation and vascular access management, thereby limiting their feasibility for long-term or ambulatory use. In contrast, splanchnic nerve ablation may lead to irreversible autonomic effects, including blood pressure instability 16 . Considering these limitations, especially in patients who remain symptomatic despite optimal medical therapy, there is a need for a more precise, reversible, and anatomically targeted strategy to modulate preload. Consequently, we developed a device-based approach that delivers cyclic compression of the SVC to intermittently restrict venous return and reduce cardiac preload. Unlike continuous occlusion, cyclic compression offers the potential for controlled cardiac unloading during specific intervals while maintaining systemic hemodynamic stability. RESULTS Experimental Model Summary and Hemodynamic Characterization We used a porcine model of heart failure induced by ischemia-reperfusion injury through coronary artery ligation, and utilized a 3D-printed device to apply defined, cyclic compression to the SVC while monitoring hemodynamic responses using right-heart catheterization and pressure-volume loop analysis. Figure 1 summarizes the experimental group assignments based on SVC compression parameters, including target compression ratios and the number of applied compression/release cycles. Figures 2 , 3 , and 4 show the design of the SVC compression device, its application, and the overall experimental workflow, respectively. Of the 17 models initially prepared, 5 were excluded due to death prior to SVC compression. Four deaths occurred during the heart failure induction phase, which involved coronary ligation and reperfusion, while one model died from ventricular fibrillation during median sternotomy for reoperation. Heart failure was successfully induced in the remaining 12 models, all of which underwent the planned SVC compression protocol. One model assigned to the 30/5 minute condition was excluded from the analysis due to insufficient sample size and a lack of physiological comparability to the other compression protocols. Conversely, the 70% continuous compression model (n = 1) was retained as a qualitative comparison subject to reference the physiological changes induced by continuous compression. Consequently, a total of 11 models were included in the final analysis. No deaths occurred during or after SVC compression, and no mortality was attributable to the intervention itself. Supplementary Table 1 provides detailed information for each model, including body weight, infarct location, timing of reoperation, compression parameters, and representative hemodynamic values at baseline and after the final compression cycle. Reoperation for SVC compression was performed an average of 14.3 ± 5.7 days after the induction of heart failure, excluding one model that underwent reoperation on postoperative day 42. This 1 to 3-week window following myocardial infarction was selected to facilitate the development of early structural remodeling and hemodynamic adaptation, capturing a transitional phase during which acute ischemic effects had subsided and early pathological changes (e.g., extracellular matrix reorganization, onset of left ventricular dilation) had begun to manifest 18,19 . Hemodynamic variables were assessed at baseline under normal conditions and subsequently re-evaluated at the time of reoperation following the induction of heart failure. In two models, baseline data could not be obtained due to constraints related to the timing of the procedure and limited personnel availability. In both instances, reliable measurements could not be acquired before the initiation of coronary artery occlusion, thereby precluding baseline evaluation. Consequently, these two models were excluded from the baseline analysis. Baseline measurements from the remaining nine models were obtained under stable conditions and utilized for intergroup comparisons (Table 1 ). MAP decreased from 86.7 ± 7.7 mmHg at baseline to 70.0 ± 9.4 mmHg after heart failure induction (p = 0.003). Central venous pressure (CVP) increased from 5.9 ± 0.8 mmHg to 7.7 ± 1.7 mmHg (p = 0.012), and systemic vascular resistance (SVR) decreased from 1650 ± 233 dyn·s·cm⁻⁵ to 1332 ± 180 dyn·s·cm⁻⁵ (p = 0.012). Although not statistically significant, SV and CO showed a decreasing trend, while HR and mean pulmonary arterial pressure (mPAP) showed an increasing trend following heart failure induction. Table 1 Hemodynamic variables measured at baseline and at the time of reoperation prior to SVC compression. Variable Baseline (n = 9) Heart failure state (n = 11) p-value HR (bpm) 90.9 ± 12.5 96.6 ± 8.0 0.31 MAP (mmHg) 86.7 ± 7.7 70.0 ± 9.4 0.003 CVP (mmHg) 5.9 ± 0.8 7.7 ± 1.7 0.012 mPAP (mmHg) 18.7 ± 3.6 20.2 ± 3.3 0.19 SV (mL) 44.0 ± 6.8 39.8 ± 9.6 0.31 CO (L/min) 3.97 ± 0.65 3.82 ± 0.81 0.63 SVR (dyn·s·cm − ⁵) 1650 ± 233 1332 ± 180 0.012 HR, heart rate; MAP, mean arterial pressure; CVP, central venous pressure; mPAP, mean pulmonary arterial pressure; SV, stroke volume; CO, cardiac output; SVR, systemic vascular resistance. Initial Trial of Continuous SVC Compression In the first model, continuous 70% SVC compression showed an initial improvement in hemodynamic parameters, followed by a subsequent decline. Initially, CO and SV increased from 4.17 L/min and 43.0 mL to 4.62 L/min and 50.9 mL, respectively, within 30 minutes. However, CO and SV subsequently declined, reaching 3.64 L/min and 40.9 mL by 90 minutes, which were below their initial measurements prior to SVC compression. Concurrently, MAP decreased steadily from 75 mmHg to 70 mmHg, suggesting diminishing cardiac filling pressures due to sustained SVC compression. This trend was accompanied by a stable heart rate and mPAP, while SVR slightly increased, reflecting progressive vasoconstriction in response to reduced cardiac output. Supplementary Fig. 2 illustrates the biphasic hemodynamic trends observed in CO, SV, and MAP. Evaluation of Cyclic Compression Strategies To address the limitations identified in Model 1, the subsequent models investigated cyclic SVC compression protocols, modifying both compression percentages and durations. In Models 2 and 3, the SVC was compressed to 100% using a 20/5 minute compression/relaxation cycle repeated seven times. This method resulted in a 3.8% increase in CO, rising from an initial 2.95 L/min to 3.06 L/min. SV increased from 25.3 mL to 27.2 mL (+ 7.6%), which may reflect a compensatory response to the observed reduction in heart rate. MAP decreased by 8.6% (74.5 mmHg to 68.1 mmHg). HR declined from 123.5 bpm to 114.5 bpm (− 7.3%), while mPAP showed minimal variation, remaining within 1 mmHg. SVR decreased by 12.1%, from 1761 dyn·s·cm⁻⁵ to 1548 dyn·s·cm⁻⁵ ( Supplementary Fig. 3 ). In Models 6 through 9, 85% compression was applied using a cyclic protocol consisting of 20 minutes of compression followed by 5 minutes of release, repeated seven times. This approach aimed to build upon the findings from Models 4 and 5 by assessing whether shorter compression durations could sustain hemodynamic benefits across multiple cycles. HR increased slightly from 100 bpm to 106 bpm by the end of Cycle 7 (p = 0.24), suggesting mild compensatory tachycardia. MAP decreased from 76.8 mmHg to 70.0 mmHg (p = 0.046), while remaining within clinically stable limits. SV increased significantly from 38.6 mL to 46.1 mL (p = 0.006), and CO rose from 3.83 L/min to 4.88 L/min (p = 0.008). Both SV and CO demonstrated consistent improvement throughout the compression protocol. The mPAP remained relatively stable (p = 0.61). Meanwhile, SVR decreased from 1446 dyn·s·cm⁻⁵ to 1025 dyn·s·cm⁻⁵ (p = 0.011) (Fig. 5 a). Representative pressure-volume loops from the 85% SVC compression with 20/5 cycles are shown in Fig. 5 b. Compared to baseline, compression cycles showed a leftward shift of the PV loop, indicating reduced preload. The lower-right corner shifted downward, consistent with a decrease in left ventricular end-diastolic pressure (LVEDP). The slope of the end-systolic pressure-volume relationship (ESPVR) also increased, suggesting improved ventricular contractility. In Models 10 through 13, 70% SVC compression was applied using a cyclic 20/5 min protocol, which resulted in numerical decreases in HR (92.5 to 86.5 bpm; p = 0.069) and MAP (65.3 to 59.3 mmHg; p = 0.28) and numerical increases in SV (42.8 to 46.3 mL; p = 0.13) and CO (3.9 to 4.0 L/min; p = 0.56). The mPAP remained stable, while SVR decreased from 1212 to 1099 dyn·s·cm⁻⁵ (− 9.4%; p = 0.069) (Fig. 6 ). Assessment of Physiological Stability Following SVC Compression We also performed arterial blood gas analysis (ABGA) on eight of the eleven models that completed the SVC compression protocol ( Supplementary Table 2 ). The arterial pH was 7.49 ± 0.05 and the HCO₃⁻ concentration was 29.7 ± 1.7 mmol/L. The PaCO₂ remained within the normal range (39.0 ± 3.6 mmHg), and electrolyte levels were stable. As baseline pH and bicarbonate levels are known to be higher in pigs than in humans 20,21 , the values observed here are likely within the normal physiological range. Lactate concentrations were normal, indicating preserved perfusion and stable hemodynamics. Intracranial pressure (ICP), estimated via lumbar cerebrospinal fluid pressure, was measured in four animals from the 85% compression model and averaged 8.5 ± 1.9 mmHg. In these animals, CVP during SVC compression was 10.0 ± 1.4 mmHg. No significant elevation in ICP was observed. DISCUSSION Current treatment for acute decompensated heart failure (ADHF) primarily relies on pharmacologic therapies such as diuretics and vasodilators 22,23 , both of which aim to reduce cardiac preload and alleviate symptoms of congestion. However, their effectiveness is often limited by adverse effects and diminishing responses with prolonged use. In addition, diuretic resistance and tolerance, which are difficult to avoid with long-term use, are important predictors of poor prognosis in heart failure 24 . Vasodilators also have limitations in patients with poor perfusion, as they can induce systemic hypotension 25,26 . Notably, no pharmacologic therapy has been shown to improve survival in ADHF 27 . While existing pharmacologic therapies form the foundation of heart failure management, a significant treatment gap remains for patients who do not respond adequately. Therefore, our goal was not to replace current treatments but to develop a complementary adjunctive therapy for this population. In this context, we investigated a preload modulation strategy employing externally applied cyclic compression of the SVC. Specifically, we compared the hemodynamic effects of three distinct compression levels—70%, 85%, and 100%—to identify the optimal degree of compression for enhancing cardiac performance in heart failure. This study demonstrated the feasibility and therapeutic relevance of a novel strategy for preload modulation through externally applied cyclic compression of the SVC. Among the various compression protocols, the 85% SVC compression model exhibited the most favorable hemodynamic profile without compromising stability. This model consistently improved CO and SV across multiple compression/release cycles. CO significantly increased from 3.83 L/min to 4.88 L/min (p = 0.008), while SV increased from 38.6 mL to 46.1 mL (p = 0.006), indicating an enhanced ventricular unloading effect. This improvement persisted throughout all seven cycles, contrasting with the temporary enhancements observed in the continuous model and the 100% compression model. The 70% model, in contrast, showed only modest increases in CO and SV. A likely explanation for this limited efficacy is that the IVC, which is longer and wider than the SVC, plays a dominant role in venous return in porcine models, with an approximate SVC-to-IVC flow ratio of 1:2 28 . Consequently, a 70% compression of the SVC alone may have a limited effect on reducing total preload. The modest decrease in SVR observed in the 85% compression model (1446 dyn·s·cm⁻⁵ to 1025 dyn·s·cm⁻⁵; p = 0.011) supports the hemodynamic benefits of preload reduction. It is noteworthy that CO increased while SVR decreased, despite the reduction in preload. This observation deviates from the expected compensatory vasoconstrictor response and suggests a complex interplay of adaptive mechanisms 29 . While improved tissue perfusion from enhanced CO likely contributed to local vasodilation, the overall positive effect on cardiac performance suggests that sympathetic activation may have primarily enhanced myocardial contractility rather than inducing systemic vasoconstriction. These results indicate that cyclic SVC compression assisted the heart in achieving a more efficient hemodynamic state. Also, considering the potential concerns regarding increases in ICP due to elevated CVP during SVC compression 30–32 , we directly measured ICP via lumbar cerebrospinal fluid pressure in the 85% compression model and found that there was no increase in cerebral pressure under these conditions. The results of this study have significant implications for the management of heart failure. We selected the 20/5 minute cycle based on two primary reasons. The 20-minute compression duration was empirically determined during the initial continuous compression trial (Model 1), as significant hemodynamic improvement was not observed until the 20-minute mark, suggesting that a shorter duration would be insufficient. The use of an intermittent cycle with a 5-minute relaxation phase was adopted for safety, building on the precedent set by earlier studies 9,17 . This combined approach allowed us to apply a therapeutically effective compression time while ensuring safety through a sufficient reperfusion period, thereby preventing venous congestion. The finding that a 20/5 minute compression/relaxation cycle can sustain hemodynamic improvements is particularly relevant when compared to prior studies. For instance, whereas some human studies demonstrated short-term stability with complete SVC occlusion for up to 10 minutes 8 , other preclinical models employing more frequent cycles raised concerns about therapy-induced hypotension 9 . The 20/5 minute cycle evaluated in this study appears to be a viable alternative that maintains improvements in CO and SV without inducing instability over repeated applications. This approach may serve as a safe and effective adjunct to prevent hemodynamic deterioration, which can occur with continuous compression or excessively prolonged compression cycles. Furthermore, the consistent improvement in CO and SV, along with the absence of pulmonary and systemic complications, suggests that this method may be clinically applicable in cases of acute decompensated heart failure or intraoperative cardiac management. It is anticipated that this device will be developed to function as an adjunct to conventional cardiac surgery rather than as a standalone treatment. Designed for safe application in proximity to adjacent large vessels, the device’s key technical feature is its ability to achieve a precise compression ratio based on the circumference of the SVC. This precision is a major advantage, allowing for controlled partial compression rather than a simple all-or-none occlusion. Such a calibrated approach is ideal for its intended role as a surgical tool. For instance, during open-heart surgery for conditions such as severe heart failure or valvular disease, surgeons could use this controllable and reversible device to precisely titrate cardiac unloading and support postoperative recovery. This study has several limitations. First, while the overall sample size (n = 11) is relatively adequate for a large animal model, the number of animals assigned to each compression condition (n = 1–4) was limited. This was primarily due to the challenges in establishing a stable ischemic heart failure model, as coronary occlusion at the mid-level LAD or the ramus intermedius often triggers intractable ventricular arrhythmias. This tendency is particularly pronounced in young, healthy porcine hearts, where coronary ligation frequently leads to early-onset fatal ventricular arrhythmia due to high myocardial excitability 33,34 . Additionally, a specific technical limitation was the use of a conductance catheter for pressure-volume loop analysis. Maintaining stable catheter positioning is a well-documented technical challenge 35 , as minor shifts due to continuous cardiac motion are nearly inevitable. These positional artifacts can result in signal fluctuations, which may explain isolated instances of paradoxical increases in LVEDP or LVEDV despite preload reduction. Therefore, the interpretation of these data should focus on the consistent overall trends toward reduced cardiac filling pressures rather than on the absolute values of individual measurements. Second, the relatively short observation period did not allow for the evaluation of adverse events, such as physiological adaptation to prolonged repeated compression, persistent venous congestion, elevated ICP, or regional perfusion imbalance. Third, neurohormonal markers were not measured, which limited insights into the compensatory or exacerbating mechanisms at the biochemical level. Finally, this study did not assess device biocompatibility or chronic implantation outcomes, as the primary aim was to evaluate short-term hemodynamic effects in an acute large-animal model. Building on the physiological principles demonstrated in this study, future research may incorporate advancements in flexible materials, as well as soft, miniaturized actuation and sensing technologies 36 . Such innovations could facilitate the development of a fully implantable, adaptive SVC compression device, potentially resulting in a closed-loop system for dynamic preload modulation. This could be particularly valuable as an adjunctive tool in the management of severe heart failure, including in perioperative or postoperative settings. In conclusion, our study demonstrated that cyclic compression of the SVC reduced left ventricular filling pressures and increased cardiac output in a porcine model of heart failure. Hemodynamic stability was maintained throughout the compression cycles, with no measurable adverse effects. These findings suggest that intermittent preload modulation through external venous compression may positively influence cardiac performance in the context of heart failure. This approach could serve as a foundation for developing adjunctive implantable systems to support preload management in patients with advanced heart failure, particularly in surgical or acute care settings. MATERIALS AND METHODS Ethical Statement The study was conducted under a protocol approved by the Institutional Animal Care and Use Committee (IACUC) at Seoul National University Bundang Hospital (BA-2404-389-003-04). The animals were housed in a facility accredited by AAALAC International (#001847) in accordance with the Guide for the Care and Use of Laboratory Animals, 8th edition, NRC (2010). Ethical standards to minimize animal suffering and ensure humane treatment were strictly adhered to throughout the study. The ARRIVE (Animal Research: Reporting of In Vivo Experiments) Guidelines 2.0 were implemented in the study design and reporting to ensure scientific reproducibility and transparency. Animal Preparation We utilized thirteen healthy male three-way crossbred pigs (Landrace × Yorkshire × Duroc), aged 4 to 5 months and weighing approximately 50 kg each, which were purchased from Cronex (Suwon, Gyeonggi-do, Republic of Korea) and housed at the Seoul National University Bundang Hospital Preclinical Research Center at Translational Research Institute. Anesthesia was induced via intramuscular injection of Zoletil (tiletamine/zolazepam, 5 mg/kg) and Rompun (xylazine, 2 mg/kg), supplemented with ketamine (20 mg/kg) as needed. Following induction, the pigs inhaled 2-3% sevoflurane in 100% oxygen. After endotracheal intubation, mechanical ventilation was initiated with 40-50% oxygen, maintaining PaCO₂ levels between 35-45 mmHg. Anesthesia was maintained with 1-2% inhaled sevoflurane. Core body temperature was kept within the range of 37-38°C using a heating pad. Peripheral venous access (18G) was secured in both ears for potential fluid resuscitation. Under ultrasound guidance, an arterial line (7Fr) was inserted into the right femoral artery for continuous blood pressure monitoring. A multi-lumen access catheter (MAC, 9Fr) was placed in the left internal jugular vein to administer maintenance fluids and supplemental medications. A Swan-Ganz thermodilution catheter (Edwards Lifesciences, Irvine, CA, USA) was introduced through the MAC's hemostasis valve to measure cardiac function and hemodynamic parameters. ECG monitoring was conducted continuously throughout the study. For perioperative infection prophylaxis, all animals received a single intramuscular injection of a combination antibiotic preparation containing procaine penicillin G (250,000 IU/mL) and streptomycin sulfate (200 mg/mL) at a dosage of 1 mL per 10 kg of body weight, administered approximately 1 hour prior to the skin incision. Heart Failure Model A left mini-thoracotomy was performed with the pigs in a supine position. An incision measuring less than 10 cm was made through the fourth or fifth intercostal space. The muscle layers were meticulously dissected in a layer-by-layer manner using electrocautery, after which the pericardium was opened and tented. This approach provided adequate exposure to the left anterior descending (LAD) artery. In certain models, the obtuse marginal (OM) arteries were found to be as well-developed as the distal LAD. Depending on the vascular anatomy, either the distal LAD, the OM artery, or both were selectively dissected. A double-ligation technique was employed using a 2-0 braided silk suture. A small, round plastic spacer was positioned between the vessel and the suture to prevent damage to the coronary artery or induce spasm due to direct contact with the suture. This plastic spacer facilitated complete occlusion by evenly distributing pressure across the vessel, thereby eliminating the risk of tearing or damaging the epicardium and myocardium that could occur from direct compression by the suture alone ( Supplementary Fig. 1 ). Snare occlusion was maintained for 120 minutes, after which the suture was carefully removed to induce reperfusion and model reperfusion injury in addition to ischemia. Following hemodynamic stabilization and confirmation of the absence of active bleeding through irrigation, a 16Fr straight chest tube was inserted through the intercostal space to evacuate residual air from the thoracic cavity. The wound was closed in layers. For postoperative analgesia, an intercostal nerve block using 0.5% bupivacaine (50 mg) was administered at the thoracotomy site. Prior to the reversal of anesthesia, the absence of air leakage was confirmed via the chest drainage system, after which the chest tube was removed. The animal was then returned to its cage. Heart failure was confirmed 8 to 42 days post-infarction, as indicated by myocardial color changes and hypokinesia observed below the ligation site. Hemodynamic variables were assessed at baseline and on the day of surgery when the SVC compression device was applied. Device Design Design of SVC Compression Device The SVC compression device was specifically designed for safe implantation around the deeply located SVC in porcine models, providing stable and controlled compression at the desired level. The device is manually operated, allowing for precise control over the compression process. It consists of two main components connected by a stainless-steel pin joint (2 mm in diameter, 10 mm in length), enabling the device to open and close, as illustrated in Figures 2a and 2b . At the opposite ends of these components, small neodymium magnets (6 mm × 3 mm × 2 mm) are embedded to securely keep the device closed and fixed in the desired position. When closed, the device compresses the SVC into a semilunar shape, thereby reducing its cross-sectional area; when opened, the SVC is released and returns to its original shape. For improved grip and handling, grooves for surgical forceps and holes for sutures are integrated, enhancing stability and control during procedures. We used an SLA 3D printer (Form 3, Formlabs, Somerville, MA, USA) to design and fabricate the device, using clear resin for its rigidity and transparency (Clear Resin V4, Formlabs, Somerville, MA, USA). Degree of SVC Compression and Device Design Parameters The degree of SVC compression achieved by the device was calculated based on the cross-sectional lumen area of the SVC, assuming a consistent circumference and a wall thickness of 2 mm. Under this assumption, the lumen area of the SVC—obtained by subtracting the wall thickness from the total cross-sectional area—was utilized to calculate the compression percentage (C). The formula for calculating the compression percentage is shown in Equation (1) : Compression percentage ( C ) = * 100 (%) — Equation (1) The compressed and normal lumen areas of the SVC were compared, as they directly represent the area available for blood flow. Using this equation, we can determine the total cross-sectional area needed to achieve the targeted compression percentage, which is essential for designing the compression device. The design parameters required to achieve the target SVC compression percentage are provided in Equation (2.1) and illustrated in Figure 2c . Based on the target compression percentage ( C ) and the measured SVC circumference ( ), the values for R and r, which define the cross-sectional shape of the device, are calculated using Equation (2.2) . The distance between the center points of R and r is defined as d and is set at 2 mm, while the SVC wall thickness is assumed to be 2 mm. This device was specifically designed to operate on an SVC with a predetermined circumference and compression percentage. Therefore, prior to conducting animal experiments, devices were prefabricated in 1 mm intervals to accommodate circumferences ranging from 60 mm to 80 mm. During the experiment, the SVC circumference was measured, and the corresponding device was selected for use. — Equation ( 2.1) — Equation (2 . 2) Installation method The procedure for installing the compression device on the SVC was as follows: Ensure there is adequate space to access the SVC and that the device can fully pass behind it. Using forceps, grasp the device in its open position, approach the SVC, and slide the device underneath to wrap it around the SVC ( Figure 2d-1 ). With the forceps positioned on the opposite side of the device's entry point, grasp the end of the device and gently lift it, allowing the device to slide around and fully encircle the SVC ( Figure 2d-2 ). Once both ends of the device are visible, bring them together to allow the embedded magnets to secure the device and compress the SVC. To release the compression, use forceps to pull the two ends of the device apart ( Figure 2d-3 ). Application of the SVC Compression Device The SVC compression procedure was conducted 1 to 3 weeks following the induction of heart failure. Animal preparation adhered to the protocol detailed in the Animal Preparation section, with an additional step: the left carotid artery was exposed using a cut-down technique, and a 7Fr introducer sheath was inserted to facilitate access to the left ventricle. A left ventricular (LV) pressure-volume catheter (MPVS Millar, Houston, TX, USA) was then advanced through the introducer sheath. Catheter positioning was guided by real-time fluoroscopy utilizing contrast agents and a C-arm radiographic projector. LV pressure and volume measurements were continuously recorded using AD Instruments’ MPVS Ultra and PowerLab hardware, along with LabChart Pro software. Following catheter placement, a heparin bolus of 5,000 units was administered to prevent thrombus formation, with additional doses of 2,000 units provided at one-hour intervals as necessary. A median sternotomy was performed to provide direct access to the heart. Following careful dissection of the SVC, the device was applied ( Figure 3c ). After placing the device on the SVC, its position was verified in real-time using a C-arm fluoroscope. Contrast dye was then used to compare the degree of compression between the upper and lower portions of the SVC to ensure proper application of the device ( Figure 3a ). After the experiment was completed, the SVC was harvested from euthanized models for further analysis. Euthanasia was performed while the animals were maintained under deep anesthesia with 2-3% sevoflurane inhalation via an endotracheal tube and mechanical ventilation, and was induced by an intravenous injection of potassium chloride (KCl). Although the vessel may have partially collapsed after euthanasia, postmortem measurements of circumference and wall thickness were used to estimate whether the device had achieved the target compression ratio, based on the anatomical parameters used during its design ( Figure 3b ). This post-experiment validation ensured that the device consistently delivered the intended degree of compression across all models. The degree of SVC compression varied among models, determined by a strategic balance between efficacy and safety. Previous studies have proposed strategies to reduce preload in order to improve heart failure management 9 . In a preclinical model, SVC therapy was applied for up to 18 hours, utilizing a duty cycle of 5 minutes of occlusion followed by 30 seconds of SVC release, which resulted in a greater than 15% decrease in mean arterial pressure (MAP) by the end of the study 9 . Clinical experience showed that a 10-minute complete occlusion exhibited short-term tolerance without inducing systemic hypotension 8 . Given that the SVC accounts for only approximately one-third of venous return, lower compression levels may have limited efficacy in reducing preload. Therefore, experiments were conducted under three compression models: 70%, 85%, and 100%, to maintain hemodynamic stability while minimizing potential complications associated with complete occlusion. Regarding compression/release (C/R) cycles, one model underwent continuous compression, while ten models experienced intermittent cycles consisting of 20 minutes of compression followed by 5 minutes of release. The timing of the C/R cycles was based on a previously established preclinical model employing a 5-minute occlusion followed by a 10-second release, which did not result in notable neurological complications 9 . This approach was further supported by a separate clinical study in which 5 minutes of occlusion was well tolerated despite a significant two-fold increase in jugular venous pressure 17 . To better reflect clinical scenarios, we extended the compression phase to 20 minutes while maintaining the 5-minute release phase to ensure adequate tissue reperfusion and minimize ischemic complications. Testing the 20/5 minute cycle at varying compression ratios (70%, 85%, and 100%) aimed to identify the optimal balance between preload reduction efficacy and hemodynamic safety under SVC compression conditions. The impact of SVC compression was evaluated by modifying the duration, degree, and frequency of compression/release cycles across eleven models. Hemodynamic parameters were assessed at the end of each compression/release cycle to determine the effects of SVC compression. The parameters assessed included left ventricular end-diastolic pressure (LVEDP), end-diastolic volume (LVEDV), cardiac output (CO), stroke volume (SV), and overall hemodynamic stability. To prevent potential impacts on cardiac function and ensure stable preload, the use of cardiovascular medications was avoided, and fluid infusion was maintained at a constant rate of 100 mL/hr throughout the study, regardless of the current blood pressure. At the conclusion of the experiment, arterial blood gas analysis was performed to assess systemic oxygenation, ventilation, and acid-base balance following SVC compression. Blood samples were drawn from the femoral arterial catheter, and measurements included pH, PaO 2 , PaCO 2 , HCO 3 - , base excess, and lactate levels. The overall experimental workflow and key procedural steps are illustrated in Figure 4 . Statistical Analysis Results are expressed as mean ± standard deviation (SD). The normality of the data was assessed using the Shapiro-Wilk test. For within-group comparisons (e.g., pre- and post-intervention measurements), paired t -tests were used for normally distributed data, while the Wilcoxon signed-rank test was utilized for non-normally distributed data. For between-group comparisons (e.g., different compression levels), unpaired two-sample t -tests or Mann–Whitney U tests were applied, depending on the data distribution. All statistical tests were two-tailed, and p-values < 0.05 were deemed statistically significant. All analyses were performed using R version 4.5.0 (http://www.r-project.org). Abbreviations ADHF Acute decompensated heart failure CO Cardiac output CVP Central venous pressure ESPVR End-systolic pressure-volume relationship HR Heart rate ICP Intracranial pressure IVC Inferior vena cava LAD Left anterior descending LV Left ventricular LVEDP Left ventricular end-diastolic pressure LVEDV Left ventricular end-diastolic volume MAP Mean arterial pressure mPAP Mean pulmonary arterial pressure OM Obtuse marginal SV Stroke volume SVC Superior vena cava SVR Systemic vascular resistance Declarations Funding This study was supported by the NAVER Digital Bio Innovation Research Fund, funded by NAVER Corporation (Grant No. 3720242080) and the Bio-Connect 2024 through Seoul National University and Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (04-2024-0041). Conflict of interest The authors declare no conflicts of interest. Author contributions SJO and AKH contributed to the conception and design of the study; JK, YK, JL, DC, and CJL contributed to the data acquisition and interpretation of data; JK, YK, JL, and CJL contributed to the data analysis; JK and YK drafted the manuscript. All authors revised the manuscript and provided final approval, agreeing to be accountable for all aspects of the work to ensure its integrity and accuracy. Data availability Data supporting this study are available from the first author (JK) upon reasonable request. References Groenewegen, A., Rutten, F. H., Mosterd, A. & Hoes, A. W. Epidemiology of heart failure. Eur. J. Heart Fail. 22 , 1342-1356 (2020). Bhatnagar, R., Fonarow, G. C., Heidenreich, P. A. & Ziaeian, B. Expenditure on heart failure in the United States: the medical expenditure panel survey 2009-2018. Heart Fail. 10 , 571-580 (2022). Sequeira, V. & van der Velden, J. Historical perspective on heart function: the Frank–Starling Law. Biophys. Rev. 7 , 421-447 (2015). Schwinger, R. et al. The failing human heart is unable to use the Frank-Starling mechanism. Circ. Res. 74 , 959-969 (1994). Konstam, M. A., Kramer, D. G., Patel, A. R., Maron, M. S. & Udelson, J. E. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc. Imaging 4 , 98-108 (2011). Hutchinson, K. R., Stewart Jr, J. A. & Lucchesi, P. A. Extracellular matrix remodeling during the progression of volume overload-induced heart failure. J. Mol. Cell. Cardiol. 48 , 564-569 (2010). Palazzuoli, A., Evangelista, I. & Nuti, R. Congestion occurrence and evaluation in acute heart failure scenario: time to reconsider different pathways of volume overload. Heart Fail. Rev. 25 , 119-131 (2020). Kapur, N. K. et al. First‐in‐human experience with occlusion of the superior vena cava to reduce cardiac filling pressures in congestive heart failure. Catheter. Cardiovasc. Interv. 93 , 1205-1210 (2019). Kapur, N. K. et al. Intermittent occlusion of the superior vena cava reduces cardiac filling pressures in preclinical models of heart failure. J. Cardiovasc. Transl. Res. 13 , 151-157 (2020). Kapur, N. K. et al. Intermittent occlusion of the superior vena cava to improve hemodynamics in patients with acutely decompensated heart failure: the VENUS-HF early feasibility study. Circ. Heart Fail. 15 , e008934 (2022). Dierckx, R. et al. Treatment of diuretic resistance with a novel percutaneous blood flow regulator: concept and initial experience. J. Card. Fail. 25 , 932-934 (2019). Zymliński, R. et al. Novel IVC doraya catheter provides congestion relief in patients with acute heart failure. Basic to Translational Science 7 , 326-327 (2022). Fudim, M. et al. Splanchnic nerve block for acute heart failure. Circulation 138 , 951-953 (2018). Málek, F. et al. Surgical ablation of the right greater splanchnic nerve for the treatment of heart failure with preserved ejection fraction: first‐in‐human clinical trial. Eur. J. Heart Fail. 23 , 1134-1143 (2021). Fudim, M. et al. Transvenous right greater splanchnic nerve ablation in heart failure and preserved ejection fraction: first-in-human study. Heart Fail. 10 , 744-752 (2022). Fudim, M. et al. Splanchnic nerve modulation in heart failure: mechanistic overview, initial clinical experience, and safety considerations. Eur. J. Heart Fail. 23 , 1076-1084 (2021). Ghoreishi, M. et al. First-in-human endovascular aortic root repair (Endo-Bentall) for acute type A dissection. Circ. Cardiovasc. Interv. 16 , e013348 (2023). RUMBERGER, J. A. Ventricular dilatation and remodeling after myocardial infarction. Mayo Clin. Proc. 69 , 664-674 (1994). Sutton, M. G. S. J. & Sharpe, N. Left ventricular remodeling after myocardial infarction: pathophysiology and therapy. Circulation 101 , 2981-2988 (2000). Hannon, J. P., Bossone, C. A. & Wade, C. E. Normal physiological values for conscious pigs used in biomedical research. Lab. Anim. Sci. 40 , 293-298 (1990). Gianotti, G. C. et al. Swine in biomedical research: normal physiological values. (2010). McDonagh, T. A. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart J. 42 , 3599-3726 (2021). Heidenreich, P. A. et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 79 , e263-e421 (2022). Wilcox, C. S., Testani, J. M. & Pitt, B. Pathophysiology of diuretic resistance and its implications for the management of chronic heart failure. Hypertension 76 , 1045-1054 (2020). Kitai, T. et al. Impact of early treatment with intravenous vasodilators and blood pressure reduction in acute heart failure. Open Heart 5 (2018). Colucci, W. S., Williams, G. H., Alexander, R. W. & Braunwald, E. Mechanisms and implications of vasodilator tolerance in the treatment of congestive heart failure. The American journal of medicine 71 , 89-99 (1981). Rossignol, P., Hernandez, A. F., Solomon, S. D. & Zannad, F. Heart failure drug treatment. The Lancet 393 , 1034-1044 (2019). Shah, A. et al. Anatomical differences between human and pig hearts and their relevance for cardiac xenotransplantation surgical technique. Case Reports 4 , 1049-1052 (2022). Manolis, A. A., Manolis, T. A. & Manolis, A. S. Neurohumoral activation in heart failure. Int. J. Mol. Sci. 24 , 15472 (2023). Masuda, H., Ogata, T. & Kikuchi, K. Physiological changes during temporary occlusion of the superior vena cava in cynomolgus monkeys. The Annals of thoracic surgery 47 , 890-896 (1989). Hansen, A. B. et al. Reducing intracranial pressure by reducing central venous pressure: assessment of potential countermeasures to spaceflight-associated neuro-ocular syndrome. J. Appl. Physiol. 130 , 283-289 (2021). Hamilton, D. R. et al. Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model. J. Ultrasound Med. 30 , 651-659 (2011). Li, X. et al. Effects of different LAD-blocked sites on the development of acute myocardial infarction and malignant arrhythmia in a swine model. J. Thorac. Dis. 6 , 1271 (2014). Shin, H. S., Shin, H. H. & Shudo, Y. Current status and limitations of myocardial infarction large animal models in cardiovascular translational research. Frontiers in bioengineering and biotechnology 9 , 673683 (2021). Wei, A. E., Maslov, M. Y., Pezone, M. J., Edelman, E. R. & Lovich, M. A. Use of pressure-volume conductance catheters in real-time cardiovascular experimentation. Heart, Lung and Circulation 23 , 1059-1069 (2014). Kim, Y. et al. SCS: Superior‐Vena‐Cava Compressing Shape‐Memory‐Alloy‐Based Implantable Device for Heart Failure. Advanced Engineering Materials , 2402632. Additional Declarations No competing interests reported. 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13:28:08","extension":"xml","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92023,"visible":true,"origin":"","legend":"","description":"","filename":"3af9b4ec681847da932bba14545dd7ce1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/c677d32a916af6e5842a11a9.xml"},{"id":94026094,"identity":"fcd0233d-c432-4d46-a888-a4811665cbba","added_by":"auto","created_at":"2025-10-21 13:28:08","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103663,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/7ef7174c6b63a791d41db61f.html"},{"id":94026462,"identity":"560720a8-0652-4de6-8aec-ea16aa58a86b","added_by":"auto","created_at":"2025-10-21 13:36:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18117,"visible":true,"origin":"","legend":"\u003cp\u003eCompression group assignments based on target SVC compression ratios and compression/release cycles. Continuous compression was applied in one model at 70%. Cyclic compression was applied at 70% (n=4, 20/5 min), 85% (n=4, 20/5 min), and 100% (n=2, 20/5 min). The numbers below each group indicate the model numbers used throughout the manuscript.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/6c4316262035eaf554b46234.png"},{"id":94025175,"identity":"8b4933ea-95fb-4e5d-b3b1-3588e70273cb","added_by":"auto","created_at":"2025-10-21 13:20:08","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":627133,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Detailed structural components of the 3D-printed SVC compression device. (b) The compressed and released states of the device. (c) Design parameters of the 3D-printed SVC compression device. (d) Installation steps of the SVC compression device on an SVC phantom. (e) SVC phantom after the installation of the SVC compression device.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/ebe391959ec36b61d3c26bda.jpeg"},{"id":94026463,"identity":"d00730db-477d-4703-a96a-323ec33226b4","added_by":"auto","created_at":"2025-10-21 13:36:08","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":369350,"visible":true,"origin":"","legend":"\u003cp\u003e(\u003cstrong\u003ea\u003c/strong\u003e) Real-time verification of the SVC compression device placement using C-arm fluoroscopy with contrast dye. The radiopaque area corresponds to the magnets embedded in the SVC compression device. The pre-compression and post-compression segments of the SVC are visible, as well as the conductance catheter positioned within the LV. (\u003cstrong\u003eb\u003c/strong\u003e) Post-experiment validation of the compression percentage on harvested SVC specimens, based on remeasurement of vessel circumference and thickness. (\u003cstrong\u003ec\u003c/strong\u003e) Intraoperative photograph of the SVC compression device in place, with the compressed segment of the SVC shown in the inset. The scale bar is calibrated to the surgical retractor.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/13256981d2b60961b5324839.jpeg"},{"id":94025179,"identity":"603ee803-4faf-418f-9e9c-d05ed151b335","added_by":"auto","created_at":"2025-10-21 13:20:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":326134,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic overview of the experimental workflow. (1) Heart Failure Induction: Ischemia-reperfusion injury was induced through coronary artery ligation and subsequent release, followed by a survival period of 1 to 3 weeks to allow ventricular remodeling. (2) Heart Failure Confirmation: The development of heart failure was confirmed based on myocardial color changes and regional hypokinesia observed during reoperation. (3) Device Application: A 3D-printed device was externally positioned around the SVC to enable cyclic compression. The percentage of compression was quantified as the residual cross-sectional area (residual area=100% – compression%).(4) Hemodynamic Monitoring: Hemodynamic parameters were measured using a Swan-Ganz catheter, and PV loop recordings were obtained using a conductance catheter. (5) Compression Parameter Adjustment: SVC compression was applied with predetermined parameters for degree, duration, and frequency according to the model.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/bf0b96df9550317d884ea1a5.png"},{"id":94026092,"identity":"0262b8f4-46aa-4221-959e-3abd4f1c131d","added_by":"auto","created_at":"2025-10-21 13:28:08","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":304736,"visible":true,"origin":"","legend":"\u003cp\u003e(a) Box plot analysis of hemodynamic changes before and after 85% SVC compression (20/5 min) across Models 6 through 9 (n=4). (b) Representative pressure-volume loops before (blue) and during (light to dark red) 85% SVC compression. (1) A leftward shift of the PV loop indicates reduced preload. (2) A downward shift of the lower-right corner indicates decreased LVEDP. (3) Steepening of the ESPVR indicates improved LV contractility.\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/e725907cbccbb2cc56f9901f.jpeg"},{"id":94026088,"identity":"080bb7db-877a-46bc-bbb2-092fe875f1d4","added_by":"auto","created_at":"2025-10-21 13:28:08","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":8719,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot analysis of hemodynamic changes before and after 70% cyclic SVC compression (20/5 min) in Models 10 through 13 (n=4).\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/fec5bbb1824882e365375ee2.png"},{"id":100070402,"identity":"0ec6652e-9493-4e8e-8851-db072dc5e923","added_by":"auto","created_at":"2026-01-12 16:17:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2659674,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/166e410f-b6bb-4a41-a1f5-a79a395a99e7.pdf"},{"id":94025187,"identity":"d4b65a2d-0c40-4ccf-91fd-63a4056a4042","added_by":"auto","created_at":"2025-10-21 13:20:08","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":515349,"visible":true,"origin":"","legend":"","description":"","filename":"SRSupplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-7502207/v1/0880e5a943a3debfd08e22e3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Device-driven cyclic compression of the superior vena cava as a preload reduction strategy to improve cardiac function in heart failure","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHeart failure is one of the leading causes of morbidity and mortality worldwide\u003csup\u003e1\u003c/sup\u003e, and the burden of this disease continues to increase despite advancements in clinical practice guidelines and various therapies, which are primarily pharmacological\u003csup\u003e2\u003c/sup\u003e. A significant change in the pathophysiology of heart failure is the increase in cardiac preload and ventricular workload, which occurs due to decreased ventricular contractility and impaired systolic function. As the Frank-Starling mechanism becomes less effective in cases of reduced ventricular function\u003csup\u003e3,4\u003c/sup\u003e, additional preload fails to enhance cardiac output; instead, it leads to myocardial strain and diminished ventricular efficiency, resulting in harmful ventricular remodeling and subsequent pulmonary and systemic congestion\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e. Considering this pathophysiology, reducing preload has become a crucial component of therapeutic strategies for managing heart failure.\u003c/p\u003e\u003cp\u003eCurrently used medications, such as diuretics and vasodilators, are effective in reducing preload; however, they are often insufficient in advanced heart failure and have several limitations, including decreased renal function, hypotension, and the development of tolerance with long-term use. Various interventional approaches have also been explored, including endovascular occlusion of the superior vena cava (SVC) to mechanically reduce venous return\u003csup\u003e8\u0026ndash;10\u003c/sup\u003e, transient inferior vena cava (IVC) flow regulation using a catheter\u003csup\u003e11,12\u003c/sup\u003e, and splanchnic nerve blockade to redistribute blood volume into the abdominal compartment\u003csup\u003e13\u0026ndash;15\u003c/sup\u003e. However, both SVC and IVC occlusion techniques involve intravascular catheterization, which may necessitate anticoagulation and vascular access management, thereby limiting their feasibility for long-term or ambulatory use. In contrast, splanchnic nerve ablation may lead to irreversible autonomic effects, including blood pressure instability\u003csup\u003e16\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eConsidering these limitations, especially in patients who remain symptomatic despite optimal medical therapy, there is a need for a more precise, reversible, and anatomically targeted strategy to modulate preload. Consequently, we developed a device-based approach that delivers cyclic compression of the SVC to intermittently restrict venous return and reduce cardiac preload. Unlike continuous occlusion, cyclic compression offers the potential for controlled cardiac unloading during specific intervals while maintaining systemic hemodynamic stability.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eExperimental Model Summary and Hemodynamic Characterization\u003c/h2\u003e\u003cp\u003eWe used a porcine model of heart failure induced by ischemia-reperfusion injury through coronary artery ligation, and utilized a 3D-printed device to apply defined, cyclic compression to the SVC while monitoring hemodynamic responses using right-heart catheterization and pressure-volume loop analysis. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the experimental group assignments based on SVC compression parameters, including target compression ratios and the number of applied compression/release cycles. Figures\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show the design of the SVC compression device, its application, and the overall experimental workflow, respectively.\u003c/p\u003e\u003cp\u003eOf the 17 models initially prepared, 5 were excluded due to death prior to SVC compression. Four deaths occurred during the heart failure induction phase, which involved coronary ligation and reperfusion, while one model died from ventricular fibrillation during median sternotomy for reoperation. Heart failure was successfully induced in the remaining 12 models, all of which underwent the planned SVC compression protocol. One model assigned to the 30/5 minute condition was excluded from the analysis due to insufficient sample size and a lack of physiological comparability to the other compression protocols. Conversely, the 70% continuous compression model (n\u0026thinsp;=\u0026thinsp;1) was retained as a qualitative comparison subject to reference the physiological changes induced by continuous compression. Consequently, a total of 11 models were included in the final analysis. No deaths occurred during or after SVC compression, and no mortality was attributable to the intervention itself.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e provides detailed information for each model, including body weight, infarct location, timing of reoperation, compression parameters, and representative hemodynamic values at baseline and after the final compression cycle. Reoperation for SVC compression was performed an average of 14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 days after the induction of heart failure, excluding one model that underwent reoperation on postoperative day 42. This 1 to 3-week window following myocardial infarction was selected to facilitate the development of early structural remodeling and hemodynamic adaptation, capturing a transitional phase during which acute ischemic effects had subsided and early pathological changes (e.g., extracellular matrix reorganization, onset of left ventricular dilation) had begun to manifest\u003csup\u003e18,19\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHemodynamic variables were assessed at baseline under normal conditions and subsequently re-evaluated at the time of reoperation following the induction of heart failure. In two models, baseline data could not be obtained due to constraints related to the timing of the procedure and limited personnel availability. In both instances, reliable measurements could not be acquired before the initiation of coronary artery occlusion, thereby precluding baseline evaluation. Consequently, these two models were excluded from the baseline analysis. Baseline measurements from the remaining nine models were obtained under stable conditions and utilized for intergroup comparisons (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). MAP decreased from 86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 mmHg at baseline to 70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 mmHg after heart failure induction (p\u0026thinsp;=\u0026thinsp;0.003). Central venous pressure (CVP) increased from 5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 mmHg to 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 mmHg (p\u0026thinsp;=\u0026thinsp;0.012), and systemic vascular resistance (SVR) decreased from 1650\u0026thinsp;\u0026plusmn;\u0026thinsp;233 dyn\u0026middot;s\u0026middot;cm⁻⁵ to 1332\u0026thinsp;\u0026plusmn;\u0026thinsp;180 dyn\u0026middot;s\u0026middot;cm⁻⁵ (p\u0026thinsp;=\u0026thinsp;0.012). Although not statistically significant, SV and CO showed a decreasing trend, while HR and mean pulmonary arterial pressure (mPAP) showed an increasing trend following heart failure induction.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHemodynamic variables measured at baseline and at the time of reoperation prior to SVC compression.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHeart failure state (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHR (bpm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e90.9\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e96.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMAP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e86.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCVP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emPAP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e18.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSV (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e44.0\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCO (L/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e3.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSVR (dyn\u0026middot;s\u0026middot;cm\u003csup\u003e\u0026minus;\u003c/sup\u003e⁵)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e1650\u0026thinsp;\u0026plusmn;\u0026thinsp;233\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e1332\u0026thinsp;\u0026plusmn;\u0026thinsp;180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eHR, heart rate; MAP, mean arterial pressure; CVP, central venous pressure; mPAP, mean pulmonary arterial pressure; SV, stroke volume; CO, cardiac output; SVR, systemic vascular resistance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInitial Trial of Continuous SVC Compression\u003c/h3\u003e\n\u003cp\u003e In the first model, continuous 70% SVC compression showed an initial improvement in hemodynamic parameters, followed by a subsequent decline. Initially, CO and SV increased from 4.17 L/min and 43.0 mL to 4.62 L/min and 50.9 mL, respectively, within 30 minutes. However, CO and SV subsequently declined, reaching 3.64 L/min and 40.9 mL by 90 minutes, which were below their initial measurements prior to SVC compression. Concurrently, MAP decreased steadily from 75 mmHg to 70 mmHg, suggesting diminishing cardiac filling pressures due to sustained SVC compression. This trend was accompanied by a stable heart rate and mPAP, while SVR slightly increased, reflecting progressive vasoconstriction in response to reduced cardiac output. \u003cb\u003eSupplementary Fig.\u0026nbsp;2\u003c/b\u003e illustrates the biphasic hemodynamic trends observed in CO, SV, and MAP.\u003c/p\u003e\n\u003ch3\u003eEvaluation of Cyclic Compression Strategies\u003c/h3\u003e\n\u003cp\u003eTo address the limitations identified in Model 1, the subsequent models investigated cyclic SVC compression protocols, modifying both compression percentages and durations. In Models 2 and 3, the SVC was compressed to 100% using a 20/5 minute compression/relaxation cycle repeated seven times. This method resulted in a 3.8% increase in CO, rising from an initial 2.95 L/min to 3.06 L/min. SV increased from 25.3 mL to 27.2 mL (+\u0026thinsp;7.6%), which may reflect a compensatory response to the observed reduction in heart rate. MAP decreased by 8.6% (74.5 mmHg to 68.1 mmHg). HR declined from 123.5 bpm to 114.5 bpm (\u0026minus;\u0026thinsp;7.3%), while mPAP showed minimal variation, remaining within 1 mmHg. SVR decreased by 12.1%, from 1761 dyn\u0026middot;s\u0026middot;cm⁻⁵ to 1548 dyn\u0026middot;s\u0026middot;cm⁻⁵ (\u003cb\u003eSupplementary Fig.\u0026nbsp;3\u003c/b\u003e).\u003c/p\u003e\u003cp\u003eIn Models 6 through 9, 85% compression was applied using a cyclic protocol consisting of 20 minutes of compression followed by 5 minutes of release, repeated seven times. This approach aimed to build upon the findings from Models 4 and 5 by assessing whether shorter compression durations could sustain hemodynamic benefits across multiple cycles. HR increased slightly from 100 bpm to 106 bpm by the end of Cycle 7 (p\u0026thinsp;=\u0026thinsp;0.24), suggesting mild compensatory tachycardia. MAP decreased from 76.8 mmHg to 70.0 mmHg (p\u0026thinsp;=\u0026thinsp;0.046), while remaining within clinically stable limits. SV increased significantly from 38.6 mL to 46.1 mL (p\u0026thinsp;=\u0026thinsp;0.006), and CO rose from 3.83 L/min to 4.88 L/min (p\u0026thinsp;=\u0026thinsp;0.008). Both SV and CO demonstrated consistent improvement throughout the compression protocol. The mPAP remained relatively stable (p\u0026thinsp;=\u0026thinsp;0.61). Meanwhile, SVR decreased from 1446 dyn\u0026middot;s\u0026middot;cm⁻⁵ to 1025 dyn\u0026middot;s\u0026middot;cm⁻⁵ (p\u0026thinsp;=\u0026thinsp;0.011) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003ea). Representative pressure-volume loops from the 85% SVC compression with 20/5 cycles are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eb. Compared to baseline, compression cycles showed a leftward shift of the PV loop, indicating reduced preload. The lower-right corner shifted downward, consistent with a decrease in left ventricular end-diastolic pressure (LVEDP). The slope of the end-systolic pressure-volume relationship (ESPVR) also increased, suggesting improved ventricular contractility.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn Models 10 through 13, 70% SVC compression was applied using a cyclic 20/5 min protocol, which resulted in numerical decreases in HR (92.5 to 86.5 bpm; p\u0026thinsp;=\u0026thinsp;0.069) and MAP (65.3 to 59.3 mmHg; p\u0026thinsp;=\u0026thinsp;0.28) and numerical increases in SV (42.8 to 46.3 mL; p\u0026thinsp;=\u0026thinsp;0.13) and CO (3.9 to 4.0 L/min; p\u0026thinsp;=\u0026thinsp;0.56). The mPAP remained stable, while SVR decreased from 1212 to 1099 dyn\u0026middot;s\u0026middot;cm⁻⁵ (\u0026minus;\u0026thinsp;9.4%; p\u0026thinsp;=\u0026thinsp;0.069) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eAssessment of Physiological Stability Following SVC Compression\u003c/h3\u003e\n\u003cp\u003eWe also performed arterial blood gas analysis (ABGA) on eight of the eleven models that completed the SVC compression protocol (\u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e). The arterial pH was 7.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05 and the HCO₃⁻ concentration was 29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 mmol/L. The PaCO₂ remained within the normal range (39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 mmHg), and electrolyte levels were stable. As baseline pH and bicarbonate levels are known to be higher in pigs than in humans\u003csup\u003e20,21\u003c/sup\u003e, the values observed here are likely within the normal physiological range. Lactate concentrations were normal, indicating preserved perfusion and stable hemodynamics.\u003c/p\u003e\u003cp\u003eIntracranial pressure (ICP), estimated via lumbar cerebrospinal fluid pressure, was measured in four animals from the 85% compression model and averaged 8.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 mmHg. In these animals, CVP during SVC compression was 10.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 mmHg. No significant elevation in ICP was observed.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCurrent treatment for acute decompensated heart failure (ADHF) primarily relies on pharmacologic therapies such as diuretics and vasodilators\u003csup\u003e22,23\u003c/sup\u003e, both of which aim to reduce cardiac preload and alleviate symptoms of congestion. However, their effectiveness is often limited by adverse effects and diminishing responses with prolonged use. In addition, diuretic resistance and tolerance, which are difficult to avoid with long-term use, are important predictors of poor prognosis in heart failure\u003csup\u003e24\u003c/sup\u003e. Vasodilators also have limitations in patients with poor perfusion, as they can induce systemic hypotension\u003csup\u003e25,26\u003c/sup\u003e. Notably, no pharmacologic therapy has been shown to improve survival in ADHF\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWhile existing pharmacologic therapies form the foundation of heart failure management, a significant treatment gap remains for patients who do not respond adequately. Therefore, our goal was not to replace current treatments but to develop a complementary adjunctive therapy for this population. In this context, we investigated a preload modulation strategy employing externally applied cyclic compression of the SVC. Specifically, we compared the hemodynamic effects of three distinct compression levels\u0026mdash;70%, 85%, and 100%\u0026mdash;to identify the optimal degree of compression for enhancing cardiac performance in heart failure.\u003c/p\u003e\u003cp\u003eThis study demonstrated the feasibility and therapeutic relevance of a novel strategy for preload modulation through externally applied cyclic compression of the SVC. Among the various compression protocols, the 85% SVC compression model exhibited the most favorable hemodynamic profile without compromising stability. This model consistently improved CO and SV across multiple compression/release cycles. CO significantly increased from 3.83 L/min to 4.88 L/min (p\u0026thinsp;=\u0026thinsp;0.008), while SV increased from 38.6 mL to 46.1 mL (p\u0026thinsp;=\u0026thinsp;0.006), indicating an enhanced ventricular unloading effect. This improvement persisted throughout all seven cycles, contrasting with the temporary enhancements observed in the continuous model and the 100% compression model.\u003c/p\u003e\u003cp\u003eThe 70% model, in contrast, showed only modest increases in CO and SV. A likely explanation for this limited efficacy is that the IVC, which is longer and wider than the SVC, plays a dominant role in venous return in porcine models, with an approximate SVC-to-IVC flow ratio of 1:2\u003csup\u003e28\u003c/sup\u003e. Consequently, a 70% compression of the SVC alone may have a limited effect on reducing total preload.\u003c/p\u003e\u003cp\u003eThe modest decrease in SVR observed in the 85% compression model (1446 dyn\u0026middot;s\u0026middot;cm⁻⁵ to 1025 dyn\u0026middot;s\u0026middot;cm⁻⁵; p\u0026thinsp;=\u0026thinsp;0.011) supports the hemodynamic benefits of preload reduction. It is noteworthy that CO increased while SVR decreased, despite the reduction in preload. This observation deviates from the expected compensatory vasoconstrictor response and suggests a complex interplay of adaptive mechanisms\u003csup\u003e29\u003c/sup\u003e. While improved tissue perfusion from enhanced CO likely contributed to local vasodilation, the overall positive effect on cardiac performance suggests that sympathetic activation may have primarily enhanced myocardial contractility rather than inducing systemic vasoconstriction. These results indicate that cyclic SVC compression assisted the heart in achieving a more efficient hemodynamic state. Also, considering the potential concerns regarding increases in ICP due to elevated CVP during SVC compression\u003csup\u003e30\u0026ndash;32\u003c/sup\u003e, we directly measured ICP via lumbar cerebrospinal fluid pressure in the 85% compression model and found that there was no increase in cerebral pressure under these conditions.\u003c/p\u003e\u003cp\u003eThe results of this study have significant implications for the management of heart failure. We selected the 20/5 minute cycle based on two primary reasons. The 20-minute compression duration was empirically determined during the initial continuous compression trial (Model 1), as significant hemodynamic improvement was not observed until the 20-minute mark, suggesting that a shorter duration would be insufficient. The use of an intermittent cycle with a 5-minute relaxation phase was adopted for safety, building on the precedent set by earlier studies\u003csup\u003e9,17\u003c/sup\u003e. This combined approach allowed us to apply a therapeutically effective compression time while ensuring safety through a sufficient reperfusion period, thereby preventing venous congestion. The finding that a 20/5 minute compression/relaxation cycle can sustain hemodynamic improvements is particularly relevant when compared to prior studies. For instance, whereas some human studies demonstrated short-term stability with complete SVC occlusion for up to 10 minutes\u003csup\u003e8\u003c/sup\u003e, other preclinical models employing more frequent cycles raised concerns about therapy-induced hypotension\u003csup\u003e9\u003c/sup\u003e. The 20/5 minute cycle evaluated in this study appears to be a viable alternative that maintains improvements in CO and SV without inducing instability over repeated applications. This approach may serve as a safe and effective adjunct to prevent hemodynamic deterioration, which can occur with continuous compression or excessively prolonged compression cycles. Furthermore, the consistent improvement in CO and SV, along with the absence of pulmonary and systemic complications, suggests that this method may be clinically applicable in cases of acute decompensated heart failure or intraoperative cardiac management. It is anticipated that this device will be developed to function as an adjunct to conventional cardiac surgery rather than as a standalone treatment. Designed for safe application in proximity to adjacent large vessels, the device\u0026rsquo;s key technical feature is its ability to achieve a precise compression ratio based on the circumference of the SVC. This precision is a major advantage, allowing for controlled partial compression rather than a simple all-or-none occlusion. Such a calibrated approach is ideal for its intended role as a surgical tool. For instance, during open-heart surgery for conditions such as severe heart failure or valvular disease, surgeons could use this controllable and reversible device to precisely titrate cardiac unloading and support postoperative recovery.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, while the overall sample size (n\u0026thinsp;=\u0026thinsp;11) is relatively adequate for a large animal model, the number of animals assigned to each compression condition (n\u0026thinsp;=\u0026thinsp;1\u0026ndash;4) was limited. This was primarily due to the challenges in establishing a stable ischemic heart failure model, as coronary occlusion at the mid-level LAD or the ramus intermedius often triggers intractable ventricular arrhythmias. This tendency is particularly pronounced in young, healthy porcine hearts, where coronary ligation frequently leads to early-onset fatal ventricular arrhythmia due to high myocardial excitability\u003csup\u003e33,34\u003c/sup\u003e. Additionally, a specific technical limitation was the use of a conductance catheter for pressure-volume loop analysis. Maintaining stable catheter positioning is a well-documented technical challenge\u003csup\u003e35\u003c/sup\u003e, as minor shifts due to continuous cardiac motion are nearly inevitable. These positional artifacts can result in signal fluctuations, which may explain isolated instances of paradoxical increases in LVEDP or LVEDV despite preload reduction. Therefore, the interpretation of these data should focus on the consistent overall trends toward reduced cardiac filling pressures rather than on the absolute values of individual measurements.\u003c/p\u003e\u003cp\u003eSecond, the relatively short observation period did not allow for the evaluation of adverse events, such as physiological adaptation to prolonged repeated compression, persistent venous congestion, elevated ICP, or regional perfusion imbalance. Third, neurohormonal markers were not measured, which limited insights into the compensatory or exacerbating mechanisms at the biochemical level. Finally, this study did not assess device biocompatibility or chronic implantation outcomes, as the primary aim was to evaluate short-term hemodynamic effects in an acute large-animal model.\u003c/p\u003e\u003cp\u003eBuilding on the physiological principles demonstrated in this study, future research may incorporate advancements in flexible materials, as well as soft, miniaturized actuation and sensing technologies\u003csup\u003e36\u003c/sup\u003e. Such innovations could facilitate the development of a fully implantable, adaptive SVC compression device, potentially resulting in a closed-loop system for dynamic preload modulation. This could be particularly valuable as an adjunctive tool in the management of severe heart failure, including in perioperative or postoperative settings.\u003c/p\u003e\u003cp\u003eIn conclusion, our study demonstrated that cyclic compression of the SVC reduced left ventricular filling pressures and increased cardiac output in a porcine model of heart failure. Hemodynamic stability was maintained throughout the compression cycles, with no measurable adverse effects. These findings suggest that intermittent preload modulation through external venous compression may positively influence cardiac performance in the context of heart failure. This approach could serve as a foundation for developing adjunctive implantable systems to support preload management in patients with advanced heart failure, particularly in surgical or acute care settings.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cem\u003eEthical Statement\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted under a protocol approved by the Institutional Animal Care and Use Committee (IACUC) at Seoul National University Bundang Hospital (BA-2404-389-003-04). The animals were housed in a facility accredited by AAALAC International (#001847) in accordance with the Guide for the Care and Use of Laboratory Animals, 8th edition, NRC (2010). Ethical standards to minimize animal suffering and ensure humane treatment were strictly adhered to throughout the study. The ARRIVE (Animal Research: Reporting of In Vivo Experiments) Guidelines 2.0 were implemented in the study design and reporting to ensure scientific reproducibility and transparency.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAnimal Preparation\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eWe utilized thirteen healthy male three-way crossbred pigs (Landrace × Yorkshire × Duroc), aged 4 to 5 months and weighing approximately 50 kg each, which were purchased from Cronex (Suwon, Gyeonggi-do, Republic of Korea) and housed at the Seoul National University Bundang Hospital Preclinical Research Center at Translational Research Institute. Anesthesia was induced via intramuscular injection of Zoletil (tiletamine/zolazepam, 5 mg/kg) and Rompun (xylazine, 2 mg/kg), supplemented with ketamine (20 mg/kg) as needed. Following induction, the pigs inhaled 2-3% sevoflurane in 100% oxygen. After endotracheal intubation, mechanical ventilation was initiated with 40-50% oxygen, maintaining PaCO₂\u0026nbsp;levels between 35-45 mmHg. Anesthesia was maintained with 1-2% inhaled sevoflurane. Core body temperature was kept within the range of 37-38°C using a heating pad. Peripheral venous access (18G) was secured in both ears for potential fluid resuscitation. Under ultrasound guidance, an arterial line (7Fr) was inserted into the right femoral artery for continuous blood pressure monitoring. A multi-lumen access catheter (MAC, 9Fr) was placed in the left internal jugular vein to administer maintenance fluids and supplemental medications. A Swan-Ganz thermodilution catheter (Edwards Lifesciences, Irvine, CA, USA) was introduced through the MAC's hemostasis valve to measure cardiac function and hemodynamic parameters. ECG monitoring was conducted continuously throughout the study.\u003c/p\u003e\n\u003cp\u003eFor perioperative infection prophylaxis, all animals received a single intramuscular injection of a combination antibiotic preparation containing procaine penicillin G (250,000 IU/mL) and streptomycin sulfate (200 mg/mL) at a dosage of 1 mL per 10 kg of body weight, administered approximately 1 hour prior to the skin incision.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eHeart Failure Model\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eA left mini-thoracotomy was performed with the pigs in a supine position. An incision measuring less than 10 cm was made through the fourth or fifth intercostal space. The muscle layers were meticulously dissected in a layer-by-layer manner using electrocautery, after which the pericardium was opened and tented. This approach provided adequate exposure to the left anterior descending (LAD) artery. In certain models, the obtuse marginal (OM) arteries were found to be as well-developed as the distal LAD. Depending on the vascular anatomy, either the distal LAD, the OM artery, or both were selectively dissected.\u003c/p\u003e\n\u003cp\u003eA double-ligation technique was employed using a 2-0 braided silk suture. A small, round plastic spacer was positioned between the vessel and the suture to prevent damage to the coronary artery or induce spasm due to direct contact with the suture. This plastic spacer facilitated complete occlusion by evenly distributing pressure across the vessel, thereby eliminating the risk of tearing or damaging the epicardium and myocardium that could occur from direct compression by the suture alone (\u003cstrong\u003eSupplementary Fig. 1\u003c/strong\u003e). Snare occlusion was maintained for 120 minutes, after which the suture was carefully removed to induce reperfusion and model reperfusion injury in addition to ischemia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing hemodynamic stabilization and confirmation of the absence of active bleeding through irrigation, a 16Fr straight chest tube was inserted through the intercostal space to evacuate residual air from the thoracic cavity. The wound was closed in layers. For postoperative analgesia, an intercostal nerve block using 0.5% bupivacaine (50 mg) was administered at the thoracotomy site. Prior to the reversal of anesthesia, the absence of air leakage was confirmed via the chest drainage system, after which the chest tube was removed. The animal was then returned to its cage.\u003c/p\u003e\n\u003cp\u003eHeart failure was confirmed 8 to 42 days post-infarction, as indicated by myocardial color changes and hypokinesia observed below the ligation site. Hemodynamic variables were assessed at baseline and on the day of surgery when the SVC compression device was applied.\u003c/p\u003e\n\u003ch2\u003eDevice Design\u0026nbsp;\u003c/h2\u003e\n\u003ch3\u003e\u003cem\u003eDesign of SVC Compression Device\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe SVC compression device was specifically designed for safe implantation around the deeply located SVC in porcine models, providing stable and controlled compression at the desired level. The device is manually operated, allowing for precise control over the compression process. It consists of two main components connected by a stainless-steel pin joint (2 mm in diameter, 10 mm in length), enabling the device to open and close, as illustrated in \u003cstrong\u003eFigures\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;2a\u003c/strong\u003e and \u003cstrong\u003e2b\u003c/strong\u003e. At the opposite ends of these components, small neodymium magnets (6 mm × 3 mm × 2 mm) are embedded to securely keep the device closed and fixed in the desired position. When closed, the device compresses the SVC into a semilunar shape, thereby reducing its cross-sectional area; when opened, the SVC is released and returns to its original shape. For improved grip and handling, grooves for surgical forceps and holes for sutures are integrated, enhancing stability and control during procedures. We used an SLA 3D printer (Form 3, Formlabs, Somerville, MA, USA) to design and fabricate the device, using clear resin for its rigidity and transparency (Clear Resin V4, Formlabs, Somerville, MA, USA).\u003c/p\u003e\n\u003ch3\u003e\u003cem\u003eDegree of SVC Compression and Device Design Parameters\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe degree of SVC compression achieved by the device was calculated based on the cross-sectional lumen area of the SVC, assuming a consistent circumference and a wall thickness of 2 mm. Under this assumption, the lumen area of the SVC—obtained by subtracting the wall thickness from the total cross-sectional area—was utilized to calculate the compression percentage (C). The formula for calculating the compression percentage is shown in \u003cstrong\u003eEquation (1)\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompression percentage\u0026nbsp;\u003c/em\u003e(\u003cem\u003eC\u003c/em\u003e) =\u0026nbsp;\u003cimg width=\"246\" height=\"49\" 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\" alt=\"image\"\u003e\u0026nbsp;* 100 (%)\u0026nbsp;—\u0026nbsp;\u003cstrong\u003eEquation (1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe compressed and normal lumen areas of the SVC were compared, as they directly represent the area available for blood flow. Using this equation, we can determine the total cross-sectional area needed to achieve the targeted compression percentage, which is essential for designing the compression device. The design parameters required to achieve the target SVC compression percentage are provided in \u003cstrong\u003eEquation (2.1)\u003c/strong\u003e and illustrated in \u003cstrong\u003eFigure 2c\u003c/strong\u003e. Based on the target compression percentage (\u003cem\u003eC\u003c/em\u003e) and the measured SVC circumference (\u003cimg width=\"29\" height=\"37\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e), the values for R and r, which define the cross-sectional shape of the device, are calculated using \u003cstrong\u003eEquation (2.2)\u003c/strong\u003e. The distance between the center points of R and r is defined as d and is set at 2 mm, while the SVC wall thickness is assumed to be 2 mm.\u003c/p\u003e\n\u003cp\u003eThis device was specifically designed to operate on an SVC with a predetermined circumference and compression percentage. Therefore, prior to conducting animal experiments, devices were prefabricated in 1 mm intervals to accommodate circumferences ranging from 60 mm to 80 mm. During the experiment, the SVC circumference was measured, and the corresponding device was selected for use.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"283\" height=\"37\" 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\" 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\" alt=\"image\"\u003e\u0026nbsp; —\u0026nbsp;\u003cstrong\u003eEquation\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003cstrong\u003e2.1)\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cimg width=\"247\" height=\"58\" src=\"data:image/png;base64,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\" alt=\"image\"\u003e\u0026nbsp; —\u0026nbsp;\u003cstrong\u003eEquation (2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003e2)\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch3\u003e\u003cem\u003eInstallation method\u0026nbsp;\u003c/em\u003e\u003c/h3\u003e\n\u003cp\u003eThe procedure for installing the compression device on the SVC was as follows:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEnsure there is adequate space to access the SVC and that the device can fully pass behind it. Using forceps, grasp the device in its open position, approach the SVC, and slide the device underneath to wrap it around the SVC (\u003cstrong\u003eFigure 2d-1\u003c/strong\u003e).\u003c/li\u003e\n \u003cli\u003eWith the forceps positioned on the opposite side of the device's entry point, grasp the end of the device and gently lift it, allowing the device to slide around and fully encircle the SVC (\u003cstrong\u003eFigure 2d-2\u003c/strong\u003e).\u003c/li\u003e\n \u003cli\u003eOnce both ends of the device are visible, bring them together to allow the embedded magnets to secure the device and compress the SVC. To release the compression, use forceps to pull the two ends of the device apart (\u003cstrong\u003eFigure 2d-3\u003c/strong\u003e).\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003e\u003cem\u003eApplication of the SVC Compression Device\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe SVC compression procedure was conducted 1 to 3 weeks following the induction of heart failure. Animal preparation adhered to the protocol detailed in the \u003cstrong\u003eAnimal Preparation\u003c/strong\u003e section, with an additional step: the left carotid artery was exposed using a cut-down technique, and a 7Fr introducer sheath was inserted to facilitate access to the left ventricle. A left ventricular (LV) pressure-volume catheter (MPVS Millar, Houston, TX, USA) was then advanced through the introducer sheath. Catheter positioning was guided by real-time fluoroscopy utilizing contrast agents and a C-arm radiographic projector. LV pressure and volume measurements were continuously recorded using AD Instruments’ MPVS Ultra and PowerLab hardware, along with LabChart Pro software. Following catheter placement, a heparin bolus of 5,000 units was administered to prevent thrombus formation, with additional doses of 2,000 units provided at one-hour intervals as necessary.\u003c/p\u003e\n\u003cp\u003eA median sternotomy was performed to provide direct access to the heart. Following careful dissection of the SVC, the device was applied (\u003cstrong\u003eFigure 3c\u003c/strong\u003e). After placing the device on the SVC, its position was verified in real-time using a C-arm fluoroscope. Contrast dye was then used to compare the degree of compression between the upper and lower portions of the SVC to ensure proper application of the device (\u003cstrong\u003eFigure 3a\u003c/strong\u003e). After the experiment was completed, the SVC was harvested from euthanized models for further analysis. Euthanasia was performed while the animals were maintained under deep anesthesia with 2-3% sevoflurane inhalation via an endotracheal tube and mechanical ventilation, and was induced by an intravenous injection of potassium chloride (KCl). Although the vessel may have partially collapsed after euthanasia, postmortem measurements of circumference and wall thickness were used to estimate whether the device had achieved the target compression ratio, based on the anatomical parameters used during its design (\u003cstrong\u003eFigure 3b\u003c/strong\u003e). This post-experiment validation ensured that the device consistently delivered the intended degree of compression across all models.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe degree of SVC compression varied among models, determined by a strategic balance between efficacy and safety. Previous studies have proposed strategies to reduce preload in order to improve heart failure management\u003csup\u003e9\u003c/sup\u003e. In a preclinical model, SVC therapy was applied for up to 18 hours, utilizing a duty cycle of 5 minutes of occlusion followed by 30 seconds of SVC release, which resulted in a greater than 15% decrease in mean arterial pressure (MAP) by the end of the study\u003csup\u003e9\u003c/sup\u003e. Clinical experience showed that a 10-minute complete occlusion exhibited short-term tolerance without inducing systemic hypotension\u003csup\u003e8\u003c/sup\u003e. Given that the SVC accounts for only approximately one-third of venous return, lower compression levels may have limited efficacy in reducing preload. Therefore, experiments were conducted under three compression models: 70%, 85%, and 100%, to maintain hemodynamic stability while minimizing potential complications associated with complete occlusion. Regarding compression/release (C/R) cycles, one model underwent continuous compression, while ten models experienced intermittent cycles consisting of 20 minutes of compression followed by 5 minutes of release. The timing of the C/R cycles was based on a previously established preclinical model employing a 5-minute occlusion followed by a 10-second release, which did not result in notable neurological complications\u003csup\u003e9\u003c/sup\u003e. This approach was further supported by a separate clinical study in which 5 minutes of occlusion was well tolerated despite a significant two-fold increase in jugular venous pressure\u003csup\u003e17\u003c/sup\u003e. To better reflect clinical scenarios, we extended the compression phase to 20 minutes while maintaining the 5-minute release phase to ensure adequate tissue reperfusion and minimize ischemic complications. Testing the 20/5 minute cycle at varying compression ratios (70%, 85%, and 100%) aimed to identify the optimal balance between preload reduction efficacy and hemodynamic safety under SVC compression conditions.\u003c/p\u003e\n\u003cp\u003eThe impact of SVC compression was evaluated by modifying the duration, degree, and frequency of compression/release cycles across eleven models. Hemodynamic parameters were assessed at the end of each compression/release cycle to determine the effects of SVC compression. The parameters assessed included left ventricular end-diastolic pressure (LVEDP), end-diastolic volume (LVEDV), cardiac output (CO), stroke volume (SV), and overall hemodynamic stability. To prevent potential impacts on cardiac function and ensure stable preload, the use of cardiovascular medications was avoided, and fluid infusion was maintained at a constant rate of 100 mL/hr throughout the study, regardless of the current blood pressure. At the conclusion of the experiment, arterial blood gas analysis was performed to assess systemic oxygenation, ventilation, and acid-base balance following SVC compression. Blood samples were drawn from the femoral arterial catheter, and measurements included pH, PaO\u003csub\u003e2\u003c/sub\u003e, PaCO\u003csub\u003e2\u003c/sub\u003e, HCO\u003csub\u003e3\u003c/sub\u003e\u003csup\u003e-\u003c/sup\u003e, base excess, and lactate levels. The overall experimental workflow and key procedural steps are illustrated in \u003cstrong\u003eFigure 4\u003c/strong\u003e.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eResults are expressed as mean ± standard deviation (SD). The normality of the data was assessed using the Shapiro-Wilk test. For within-group comparisons (e.g., pre- and post-intervention measurements), paired\u0026nbsp;\u003cem\u003et\u003c/em\u003e-tests were used for normally distributed data, while the Wilcoxon signed-rank test was utilized for non-normally distributed data. For between-group comparisons (e.g., different compression levels), unpaired two-sample\u0026nbsp;\u003cem\u003et\u003c/em\u003e-tests or Mann–Whitney\u0026nbsp;\u003cem\u003eU\u003c/em\u003e tests were applied, depending on the data distribution. All statistical tests were two-tailed, and p-values \u0026lt; 0.05 were deemed statistically significant. All analyses were performed using R version 4.5.0 (http://www.r-project.org).\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eADHF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAcute decompensated heart failure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCardiac output\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCVP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCentral venous pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eESPVR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEnd-systolic pressure-volume relationship\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHeart rate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntracranial pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIVC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInferior vena cava\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLAD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLeft anterior descending\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLeft ventricular\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLVEDP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLeft ventricular end-diastolic pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLVEDV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLeft ventricular end-diastolic volume\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean arterial pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003emPAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMean pulmonary arterial pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eObtuse marginal\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStroke volume\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSVC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSuperior vena cava\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSVR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSystemic vascular resistance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the NAVER Digital Bio Innovation Research Fund, funded by NAVER Corporation (Grant No. 3720242080) and the Bio-Connect 2024 through Seoul National University and Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (04-2024-0041).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSJO and AKH contributed to the conception and design of the study; JK, YK, JL, DC, and CJL contributed to the data acquisition and interpretation of data; JK, YK, JL, and CJL contributed to the data analysis; JK and YK drafted the manuscript. All authors revised the manuscript and provided final approval, agreeing to be accountable for all aspects of the work to ensure its integrity and accuracy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting this study are available from the first author (JK) upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGroenewegen, A., Rutten, F. H., Mosterd, A. \u0026amp; Hoes, A. W. Epidemiology of heart failure. \u003cem\u003eEur. J. Heart Fail.\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 1342-1356 (2020).\u003c/li\u003e\n\u003cli\u003eBhatnagar, R., Fonarow, G. C., Heidenreich, P. A. \u0026amp; Ziaeian, B. 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Current status and limitations of myocardial infarction large animal models in cardiovascular translational research. \u003cem\u003eFrontiers in bioengineering and biotechnology\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 673683 (2021).\u003c/li\u003e\n\u003cli\u003eWei, A. E., Maslov, M. Y., Pezone, M. J., Edelman, E. R. \u0026amp; Lovich, M. A. Use of pressure-volume conductance catheters in real-time cardiovascular experimentation. \u003cem\u003eHeart, Lung and Circulation\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 1059-1069 (2014).\u003c/li\u003e\n\u003cli\u003eKim, Y.\u003cem\u003e et al.\u003c/em\u003e SCS: Superior‐Vena‐Cava Compressing Shape‐Memory‐Alloy‐Based Implantable Device for Heart Failure. \u003cem\u003eAdvanced Engineering Materials\u003c/em\u003e, 2402632.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Heart failure, Preload, Vena cava, Hemodynamics","lastPublishedDoi":"10.21203/rs.3.rs-7502207/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7502207/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe evaluated the physiological efficacy and safety of a novel device-based preload reduction strategy that applies external cyclic compression to the superior vena cava (SVC) in a preclinical heart failure model. Heart failure was induced in eleven pigs using ischemia\u0026ndash;reperfusion injury, and a 3D-printed SVC compression device was tested under varying compression ratios and protocols. Hemodynamic responses were monitored using right-heart catheterization and pressure\u0026ndash;volume loop analysis. Among the tested conditions, cyclic compression at 85% with 20/5-minute compression\u0026ndash;release cycles produced the most favorable effects. Cardiac output increased by 27.3% (3.83 to 4.88 L/min, p\u0026thinsp;=\u0026thinsp;0.008) and stroke volume by 19.5% (38.6 to 46.1 mL, p\u0026thinsp;=\u0026thinsp;0.006), while mean arterial and pulmonary pressures remained stable. Systemic vascular resistance decreased by 29.0% (1,200 to 852 dyn\u0026middot;s/cm⁵, p\u0026thinsp;=\u0026thinsp;0.011), accompanied by reductions in left ventricular end-diastolic pressures and improved contractility. These results demonstrate that externally applied cyclic SVC compression effectively reduces preload and augments cardiac performance without compromising hemodynamic stability. Our study provides a proof-of-concept for the clinical utility of a device-driven external cyclic compression of the SVC as an adjunctive therapy for acute decompensated heart failure, especially in perioperative or critical care settings, and supports further development toward an implantable clinical system.\u003c/p\u003e","manuscriptTitle":"Device-driven cyclic compression of the superior vena cava as a preload reduction strategy to improve cardiac function in heart failure","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 13:20:03","doi":"10.21203/rs.3.rs-7502207/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-29T03:59:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-17T15:43:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T23:34:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T03:03:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-12T23:05:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222132529091317017503261553827024340052","date":"2025-10-12T22:58:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29378447071876922316102253958917658320","date":"2025-10-09T23:16:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63202856629786118994665418774541503381","date":"2025-10-08T22:14:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307043297791175481893185434560250758415","date":"2025-10-08T15:18:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T13:35:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T13:34:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-10T07:29:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T03:19:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-08T13:45:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"276c3957-a650-42c7-94a2-af24038c9417","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":56487572,"name":"Health sciences/Cardiology"},{"id":56487573,"name":"Health sciences/Medical research"},{"id":56487574,"name":"Biological sciences/Physiology"}],"tags":[],"updatedAt":"2026-01-12T16:13:42+00:00","versionOfRecord":{"articleIdentity":"rs-7502207","link":"https://doi.org/10.1038/s41598-026-35769-y","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-10 15:58:53","publishedOnDateReadable":"January 10th, 2026"},"versionCreatedAt":"2025-10-21 13:20:03","video":"","vorDoi":"10.1038/s41598-026-35769-y","vorDoiUrl":"https://doi.org/10.1038/s41598-026-35769-y","workflowStages":[]},"version":"v1","identity":"rs-7502207","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7502207","identity":"rs-7502207","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}