The Automated Fluid Shunt (AFS)in Chronic Congestive Heart Failure

Inclusion Criteria: * Female or male patients ≥ 18 years of age * A clinical diagnosis of chronic congestive heart failure \> 6 months * At least one episode of documented ADHF during the previous 6 months * NYHA functional class III-IV * Circulating levels of NT-proBNP ≥ 800 ng/L. * Stable, optimized therapy for heart failure for at least 4 weeks prior to enrollment * Echocardiography performed within 3 months * Detectable ascites by ultrasound and/or computed tomography * Diuretic resistance defined as a daily dose of furosemide \> 80 mg, torsemide \> 40 mg or bumetanide \> 2 mg * Written informed consent Exclusion Criteria: * Present or recurring systemic or local infection, such as peritonitis, urinary tract infection, or abdominal skin infection. * Ongoing malignant disease with adverse prognosis * Evidence of firmly loculated peritoneal effusion. * Obstructive uropathy * Severely reduced renal function (S-Creatinine 300 mol/l) or end-stage renal disease requiring dialysis * Severe liver disease (ASAT and/or ALAT and/or total bilirubin three times upper limit of normal range laboratory values) * Pregnancy * Requirement for intravenous inotropes * Acute coronary syndrome or any condition requiring emergency treatment * Heart disease requiring surgical intervention during the course of the study * Any other clinically significant disease that could be adversely affected by study participation judged by the Investigator