Early promise for pulmonary artery denervation in PAH patients

By Eleanor McDermid, Senior medwireNews Reporter

Pulmonary artery denervation is feasible and may reduce pulmonary arterial pressure (PAP) in patients with pulmonary arterial hypertension (PAH), phase II findings suggest.

For the study, Shao-Liang Chen (Nanjing Medical University, China) and co-researchers performed pulmonary artery denervation in 66 patients who had a resting mean (m)PAP of at least 25 mmHg (average of 41.4 mmHg), despite treatment.

The patients included those with idiopathic PAH, chronic thromboembolic PAH, and PAH secondary to connective tissue disorders, congenital heart disease and left ventricular dysfunction.

Compared with before the procedure, patients’ mPAP was an average of 5 mmHg lower immediately after, 6.6 mmHg lower 24 hours later and remained reduced during 1 year of follow-up. Haemodynamic success, defined as at least a 10% reduction in mPAP, was achieved in 93.9% of the patients.

The sustained effect over 1 year implies that pulmonary artery denervation “might be beneficial for a wide variety of PAH causes”, comment the researchers.

Systolic and diastolic PAP were also significantly reduced during follow-up, as were right atrial pressure and right ventricular systolic pressure, while cardiac output increased.

Patients’ average 6-minute walk distance increased by a significant 94 metres, their N-terminal pro–brain natriuretic peptide levels significantly decreased and 63.6% had an improvement in World Health Organization functional class.

There were no direct complications of pulmonary artery denervation, the team reports in Circulation: Cardiovascular Interventions. However, 10 patients had a PAH-related adverse event during the 1-year follow-up, and five of the eight deaths that occurred were due to right ventricle failure. The other three deaths were due to septic shock, cerebral haemorrhage and a traffic accident.

In a related editorial, Jane Leopold (Harvard Medical School, Boston, Massachusetts, USA) cautions that “firm conclusions are limited by the small and heterogeneous nature of the study population, the open-label nonrandomized study design, and the limited number of operators performing the procedure.”

But she says: “The study does, however, provide the basis for a multicenter randomized placebo-controlled clinical trial that is necessary to determine if this therapy has efficacy in the treatment of PAH.”

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