An Automated Continual Water Removal System in Patients With Advanced Diuretic Resistant Heart Failure

Inclusion Criteria: * ≥ 21 years of age * Life expectancy \> 6 months * HF, NYHA class II-IV * \> 1 HF related admissions in the last 12 months * Fluid congestion (2 signs of pitting oedema, jugular distention, BW elevation, nocturnal dyspnoea score, respiration rate, pulmonary congestion and/or pleural effusion per chest x-ray, ascites) * Failure to achieve effective diuresis and congestion relief despite appropriate or escalating diuretic doses or combination of diuretics (eg. Furosemide and Metolazone) * Eligible for general anaesthesia and laparoscopic procedure * Able to give written informed consent * Ability to comply with study procedures and ability to operate the device * Women of childbearing potential should use adequate contraception for as long as the device is implanted. Exclusion Criteria: * • Any non-cardiac disease with life expectancy \< 1 year * Any patient listed for solid organ transplantation * Patients with history, or with indication for, mechanical circulatory support * iv inotropes required in last 3 months (INTERMACS Score ≤3) * Immunocompromised (e.g. chronic steroid treatment, HIV, etc.) * Insulin dependent diabetes * Severe hyponatraemia as defined by a serum Sodium \< 120 mmol/l * Serum Albumin \< 2.5 g/dL * eGFR \< 25 ml/min/1.73m2 by MDRD method * Previous significant intraabdominal surgery, severe abdominal adhesions, intra-abdominal foreign body (except for small inguinal mesh) * Large diaphragmatic hernia, or surgically irreparable, complex or recurring hernia * 6 minutes' walk test of less than 100 meter * History (\>6 months) of diaphragmatic hernia, inflammatory or ischemic bowel disease and frequent episodes of diverticulitis * Gastrointestinal haemorrhage within the last 4 months * Bacterial peritonitis episode within the last 24 months * \> 2 systemic or local infections, such as urinary tract infection or abdominal skin infection within the last 6 months * Liver cirrhosis * BMI \> 40 presenting a risk for surgery * Patients with contraindications for general anaesthesia or laparoscopic surgery * Unsuitability for self-maintenance of the experimental home set-up * Presence of any current cancer * Presence of any active implantable or body-worn devices that cannot be removed excluding ICD / pacemaker * Pregnancy * Patients being in another therapeutic clinical study