REDUCE LAP-HF TRIAL II

SELECT INCLUSION CRITERIA * Chronic symptomatic Heart Failure (HF) documented by one or more of the following: * Symptoms of HF requiring current treatment with diuretics for ≥ 30 days AND * NYHA class II with a history of \> NYHA class II; OR NYHA class III, or ambulatory NYHA class IV symptoms (paroxysmal nocturnal dyspnea, orthopnea, dyspnea on mild or moderate exertion) at screening; or signs (any rales post cough, chest x-ray demonstrating pulmonary congestion,) within past 12 months; AND * ≥ 1 HF hospital admission (with HF as the primary, or secondary diagnosis); or treatment with intravenous (IV), or intensification of oral diuresis for HF in a healthcare facility within the 12 months prior to study entry; OR an NT-pro BNP value \> 150 pg./ml in normal sinus rhythm, \> 450 pg./ml in atrial fibrillation, or a BNP value \> 50 pg./ml in normal sinus rhythm, \> 150 pg./ml in atrial fibrillation within the past 6 months. * Ongoing stable GDMT HF management and management of potential comorbidities according to the 2013 ACCF/AHA Guidelines for the management of Heart Failure (with no significant changes \[\>100% increase or 50% decrease\], excluding diuretic dose change for a minimum of 4 weeks prior to screening) that is expected to be maintained without change for 6 months * Age ≥ 40 years old, LV ejection fraction (EF) ≥ 40% within the past 3 months, without previously documented EF \<30% (within the past 3 years) * Elevated PCWP with a gradient compared to right atrial pressure (RAP), documented by end-expiratory PCWP during supine ergometer exercise ≥ 25mmHg, and greater than RAP by ≥ 5 mmHg SELECT EXCLUSION CRITERIA * MI and/or percutaneous cardiac intervention within past 3 months; CABG in past 3 months, or current indication for coronary revascularization; AVR (surgical AVR or TAVR) within the past 12 months. * Cardiac Resynchronization Therapy initiated within the past 6 months * Advanced heart failure defined as one or more of the below: * ACC/AHA/ESC Stage D heart failure, non-ambulatory NYHA Class IV HF; * Cardiac index \< 2.0 L/min/m2 * Inotropic infusion (continuous or intermittent) for EF\< 40% within the past 6 months * Patient is on the cardiac transplant waiting list * Inability to perform 6 minute walk test (distance \< 50 m), OR 6 minute walk test \> 600m * History of stroke, transient ischemic attack (TIA), deep vein thrombosis (DVT), or pulmonary emboli within the past 6 months * Presence of significant valve disease defined by the site cardiologist as: * Mitral valve regurgitation defined as grade ≥ 3+ MR * Tricuspid valve regurgitation defined as grade ≥ 2+ TR * Aortic valve disease defined as ≥ 2+ AR or \> moderate AS * Known clinically significant untreated carotid artery stenosis likely to require intervention * Currently requiring dialysis; or estimated-GFR \<25ml/min/1.73 m2 by CKD-Epi equation