Pulmonary Artery Denervation Procedure May Improve Hemodynamic Outcomes in PAH

San Francisco, CA—Pulmonary artery denervation was associated with significant reductions in pulmonary artery pressure in a cohort of patients with pulmonary arterial hypertension (PAH).

Of the 21 patients who underwent analysis, 13 were assigned to the studied pulmonary artery denervation procedure. The eight who refused served as controls.

Shaoliang Chen, MD, of Nanjing First Hospital of Nanjing Medical Center
in Jiangsu, China, and colleagues, noted that the procedure was used for bifurcation of the main pulmonary artery and at the ostial right and left pulmonary artery.

“IPAH is considered as "Cancer of Cardiology,”” Chen said. “Several targeting drugs are associated with severe side effects and with mild reduction of pulmonary pressure. More patients can not afford higher cost drugs.”

Patients underwent serial echocardiography, right heart catheterization and a 6-minute walk test. Change in pulmonary artery pressure, tricuspid excursion index and the walk test at 6 months served as the primary outcome measures.

Three-month results indicated that pulmonary artery pressure decreased significantly (from 55±5 mm Hg to 36±5 mm Hg; P<.01) in the treatment group compared with the control group. Pulmonary artery denervation also yielded improvements in the walk test (from 324±21 m to 491±38 m; P<.006) and tricuspid excursion index (from 0.3±0.04 to 0.50±0.04; P<.001) compared with controls.

Previous results indicated that pulmonary artery denervation “completely abolished the experimentally elevated pulmonary artery pressure responses” when the left interlobar pulmonary artery was occluded, according to the researchers. They added that localization of baroreceptors and sympathetic nerve fibers occurs in or near the bifurcation area of the main pulmonary artery.

The investigators noted that the results are the first to demonstrate functional capacity and hemodynamics of pulmonary artery denervation in this patient population. They suggested that further randomized analysis is necessary.

“The main finding is that PADN significantly reduced pulmonary pressure and improved IPAH patients' clinical outcomes, as such increased 6-minute walk distance at follow-up,” Chen said. “The study confirmed the role of sympathetical nerves in modulating pulmonary vascular tone. PADN will bring a new approach for IPAH patients.”