Pulmonary Artery Denervation for Patients With Residual Pulmonary Hypertension After Pulmonary Endarterectomy

• Published in: Journal of the American College of Cardiology 2020-08, Vol.76 (8), p.916-926
• Main Authors: Romanov, Alexander, Cherniavskiy, Alexander, Novikova, Nataliya, Edemskiy, Alexander, Ponomarev, Dmitry, Shabanov, Vitaliy, Losik, Denis, Elesin, Dmitry, Stenin, Ilya, Mikheenko, Igor, Zhizhov, Roman, Kretov, Evgeny, Pokushalov, Evgeny, Po, Sunny S, Martynyuk, Tamila V, Steinberg, Jonathan S
• Format: Article
• Language: English
• Subjects: Cardiac Catheterization - methods; Denervation - instrumentation; Denervation - methods; Endarterectomy - adverse effects; Endarterectomy - methods; Enzyme Activators - administration & dosage; Female; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - therapy; Male; Middle Aged; Pulmonary Artery - innervation; Pulmonary Artery - surgery; Pulmonary Embolism - complications; Pulmonary Wedge Pressure - physiology; Pyrazoles - administration & dosage; Pyrimidines - administration & dosage; Surgery, Computer-Assisted - methods; Treatment Outcome; Vascular Resistance - physiology; Walk Test - methods
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2020.06.064

Pulmonary artery denervation (PADN) procedure has not been applied to patients with residual chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary endarterectomy (PEA). This study sought to assess the safety and efficacy of PADN using remote magnetic navigation in patients with residual CTEPH after PEA. Fifty patients with residual CTEPH despite medical therapy at least 6 months after PEA, who had mean pulmonary artery pressure ≥25 mm Hg or pulmonary vascular resistance (PVR) > 400 dyn‧s‧cm based on right heart catheterization were randomized to treatment with PADN (PADN group; n = 25) using remote magnetic navigation for ablation or medical therapy with riociguat (MED group; n = 25). In the MED group, a sham procedure with mapping but no ablation was performed. The primary endpoint was PVR at 12 months after randomization. Key secondary endpoint included 6-min walk test. After PADN procedure, 2 patients (1 in each group) developed groin hematoma that resolved without any consequences. At 12 months, mean PVR reduction was 258 ± 135 dyn‧s‧cm in the PADN group versus 149 ± 73 dyn‧s‧cm in the MED group, mean between-group difference was 109 dyn‧s‧cm (95% confidence interval: 45 to 171; p = 0.001). The 6-min walk test distance was significantly increased in the PADN group as compared to distance in the MED group (470 ± 84 m vs. 399 ± 116 m, respectively; p = 0.03). PADN in patients with residual CTEPH resulted in substantial reduction of PVR at 12 months of follow-up, accompanied by improved 6-min walk test.