Author + information
The mechanisms underlying pulmonary arterial hypertension (PAH) are multifactorial. The efficacy of pulmonary artery denervation (PADN) for idiopathic PAH treatment has been evaluated. This study aimed to analyze the hemodynamic, functional, and clinical responses to PADN in patients with PAH of different etiologies.
Methods and Results
Between April 2012 and April 2014, 66 consecutive patients with a resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg treated with PADN were prospectively followed. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance (6MWD) were repeatedly measured within the 1-year post-PADN follow-up. The clinical endpoint was the occurrence of PAH-related events at the 1-year follow-up. There were no PADN-related complications. Hemodynamic success (defined as the reduction in mPAP by a minimal 10% post-PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic PAP and mPAP within 24 h were -10 mmHg and -7 mmHg, respectively. The average increment in 6MWD after PADN was 94 m. Worse PAH-related events occurred in 10 (15%) patients, mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths.
PADN was safe and feasible for the treatment of PAH. The PADN procedure was associated with significant improvements in hemodynamic function, exercise capacity and cardiac function, and with less frequent PAH-related events and death at 1 year after PADN treatment. Further randomized studies are required to confirm the efficacy of PADN for PAH.