Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Abstract

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

Determinants of prognosis and management of patients with pulmonary hypertension due to left heart disease: a systematic review

“…Денервация легочный артерий при ЛГ до сих пор остается не до конца изученным направлением, применяющимся в единичных Федеральных центрах страны в основном в рамках научных направлений для пациентов с хронической тромбоэмболической ЛГ в дополнении к хирургическому лечению [32], а также у кардиохирургических пациентов с приобретенными пороками сердца и ЛГ [33]. Российскими авторами был проведен анализ 8 исследований, посвященных денервации легочной артерии при ЛГ различного генеза, в т.ч.…”

Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

“…All these uncertainties are especially relevant in the subgroup of patients with Group 2 PH, where we have no convincing evidence of the effectiveness of the intervention. Despite this, percutaneous PA denervation is already being applied to patients with PH secondary to left heart disease [80,[83][84][85]97,101]. Given the uncertainty that still many experts share about the effectiveness of PA denervation as a treatment for chronic PH [11,102,103], there is a need for randomized, controlled, multicenter blinded studies in this field [104,105].…”

Reply: Ablating atrial fibrillation for tricuspid valve

“…Honestly, as we have not enough knowledge and experience on this procedure and its impact on outcomes, we are in a position to learn about this from experts like Yegorovich and colleagues, and I read their recent paper focusing on this issue with great interest. 6 Although the paper has inherent limitations of observational studies bearing selection bias, there seems to be potential in this pulmonary artery denervation to investigate further to see whether this may improve rhythm outcomes and thereby help reverse PHT.…”