Meta-analysis of Pulmonary Artery Denervation for Treatment of Pulmonary Hypertension

Abstract

Objective: Pulmonary artery denervation (PADN) can reduce sympathetic nervous system (SNS) activity in patients with pulmonary hypertension (PH), reduce pulmonary artery pressure (PAP) in PH patients, and improve the quality of life in PH patients. We conducted a systematic meta-analysis of the effectiveness of PADN in the treatment of PH patients. Methods: All public clinical trials investigating the effects of PADN on PH. Outcomes were average pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output (CO), right ventricular (RV) Tei index, 6-minute walk distance (6MWD), and New York Heart Association (NYHA) cardiac function grading. Results: A total of eight clinical studies including 213 PH patients with PADN were included. Meta-analysis showed that after PADN, mPAP (MD -12.51, 95% CI -17.74 to -7.27, P＜0.00001) (mmHg) and PVR (MD = -5.17, 95% CI -7.70 to -2.65, P <0.0001) (wood unit) decreased significantly, CO (MD 0.59, 95% CI 0.32 to 0.86, P＜0.0001) (L/min) and 6MWD (MD 107.75, 95% CI 65.64 to 149.86, P ＜0.00001) (meter) increased significantly, and RV Tei index (MD -0.05, 95% CI -0.28 to 0.17, P = 0.63) did not change significantly. And after PADN, the proportion of NYHA cardiac function grading (RR = 0.23, 95% CI 0.14 to 0.37, P <0.00001) III and IV decreased significantly.Conclusion: This meta-analysis supports PADN as a potential new treatment for PH. Further high-quality randomized controlled studies are needed.