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We propose to address this underlying pathophysiology with selective blockade of sympathetic signalling to the splanchnic circulation by surgical ablation of the right greater splanchnic nerve (GSN).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      In a single\u2010arm, prospective, two\u2010centre trial, 10 patients with HFpEF (50% male, mean age 70\u2009\u00b1\u20093\u2009years) all with New York Heart Association (NYHA) class III, left ventricular ejection fraction &gt;40%, pulmonary capillary wedge pressure (PCWP) \u226515\u2009mmHg at rest or \u226525\u2009mmHg with supine cycle ergometry, underwent ablation of the right GSN via thoracoscopic surgery. Patients were evaluated at baseline, 1, 3, 6 and 12\u2009months after the procedure. The primary endpoint was a reduction in exercise PCWP at 3\u00a0months. There were no adverse events related to the blockade of the nerve during 12\u2010month follow\u2010up but three patients had significant peri\u2010procedural adverse events related to the surgical procedure itself. At 3\u2009months post\u2010GSN ablation, patients demonstrated a reduction in 20\u2009W exercise PCWP when compared to baseline [\u22124.5\u2009mmHg (95% confidence interval, CI \u221214 to \u22122);\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0059], which carried over to peak exercise [\u22125\u2009mmHg (95% CI \u221211 to 0;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.016). At 12\u2009months, improvements were seen in NYHA class [3 (3) vs. 2 (1, 2);\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0039] and quality of life assessed with the Minnesota Living with Heart Failure Questionnaire [60 (51, 71) vs. 22 (16, 27);\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.0039].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this first\u2010in\u2010human study, GSN ablation in HFpEF proved to be feasible, with a suggestion of reduced cardiac filling pressure during exercise, improved quality of life and exercise capacity.<\/jats:p>\n                  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