Hemodynamic, Functional, and Clinical Responses to Pulmonary Artery Denervation in Patients With Pulmonary Arterial Hypertension of Different Causes

P ulmonary arterial hypertension (PAH) is a debilitating condition that results in dyspnea and fatigue, impaired exercise capacity, and reduced survival. 1 Modest improvements in 6-minute walk distance (6MWD) can be achieved with endothelial-receptor antagonists, phosphodiesterase type-5 inhibitors, and prostacyclin analogs, 1–3 although the extent of improvement varies according to the cause of PAH, 2 and the effects on morbidity and mortality are less certain. 4 Combination therapy with multiple drugs targeting different pathways has been recommended, increasing the likelihood of side effects. Sympathetic overactivation has been reported, and the effect of β-blockers in PAH patients has been assessed. 1 Pulmonary artery nerve denervation could completely resolve the increase in pulmonary arterial pressure (PAP) induced by an expandable device in the left lobar artery. 7,8 Furthermore, we reported short-term clinical results of pulmonary artery denervation (PADN) without the use of PAH target drugs, which was associated with significant reductions in PAP and improvement in 6MWD at the 3-month follow-up in patients Background—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 causes. consecutive patients with a resting mean pulmonary arterial pressure ≥25 mm Hg treated with PADN were prospectively followed up. Target drugs were discontinued after the PADN procedure. Hemodynamic response and 6-minute walk distance were repeatedly measured within the 1 year post PADN follow-up. The clinical end point 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 mean pulmonary arterial pressure by a minimal 10% post PADN) was achieved in 94% of all patients, with a mean absolute reduction in systolic pulmonary arterial pressure and mean pulmonary arterial pressure within 24 hours of −10 mm Hg and −7 mm Hg, respectively. The average increment in 6-minute walk distance after PADN was 94 m. Worse PAH-related events occurred in 10 patients (15%), mostly driven by the worsening of PAH (12%). There were 8 (12%) all-cause deaths, with 6 (9%) PAH-related deaths. Conclusions—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 …