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

Romanov, Alexander; Cherniavskiy, Alexander; Novikova, Nataliya; Edemskiy, Alexander; Ponomarev, Dmitry; Шабанов, В. В.; Losik, Denis; Елесин, Д. А.; Стенин, И. Г.; Mikheenko, I.; Жижов, Р. Э.; Kretov, Еvgeny; Pokushalov, Evgeny; Po, Sunny S.; Martynyuk, T V; Steinberg, Jonathan S.

doi:10.1016/j.jacc.2020.06.064

Cited by 52 publications

(29 citation statements)

References 28 publications

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“…Furthermore, while PEA is potentially curative, up to 51% of patients will experience persistent/recurrent CTEPH after surgery [6,27]. Recent evidence from a prospective, pilot, randomized, sham-controlled clinical trial suggests pulmonary artery denervation using remote magnetic navigation may potentially benefit these patients; improvements were seen in PVR (mean difference 109 dyn‧s‧ cm − 5 [95% confidence interval {CI}, 45 to 171]; p < 0.001) and 6-min walking distance (6MWD) (71 m [95% CI, 13 to 129]; p = 0.03) for patients receiving this procedure (n = 25) versus patients receiving the sham procedure (n = 25) [33]. Though promising, these findings need to be confirmed in a larger trial.…”

Section: Pulmonary Endarterectomymentioning

confidence: 99%

Interventional and pharmacological management of chronic thromboembolic pulmonary hypertension

Ghofrani

D’Armini

Kim

et al. 2021

Respiratory Medicine

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Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by obstruction of the pulmonary vasculature, leading to increased pulmonary vascular resistance and ultimately right ventricular failure, the leading cause of death in non-operated patients. This article reviews the current management of CTEPH. The standard of care in CTEPH is pulmonary endarterectomy (PEA). However, up to 40% of patients with CTEPH are ineligible for PEA, and up to 51% develop persistent/recurrent PH after PEA. Riociguat is currently the only medical therapy licensed for treatment of inoperable or persistent/recurrent CTEPH after PEA based on the results of the Phase III CHEST-1 study. Studies of balloon pulmonary angioplasty (BPA) have shown benefits in patients with inoperable or persistent/recurrent CTEPH after PEA; however, data are lacking from large, prospective, controlled studies. Studies of macitentan in patients with inoperable CTEPH and treprostinil in patients with inoperable or persistent/recurrent CTEPH showed positive results. Combination therapy is under evaluation in CTEPH, and long-term data are not available. In the future, CTEPH may be managed by PEA, medical therapy or BPAalone or in combination, according to individual patient needs. Patients should be referred to experienced centers capable of assessing and delivering all options.

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Section: Pulmonary Endarterectomymentioning

confidence: 99%

Interventional and pharmacological management of chronic thromboembolic pulmonary hypertension

Ghofrani

D’Armini

Kim

et al. 2021

Respiratory Medicine

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“…In the clinical area, we have data from five studies on PA denervation in patients with PH, only two of them being randomized trials [85,86], see Table 3. Briefly, shortly after their first experimental proof, in 2013, Chen et al directly applied percutaneous PA denervation to a group of 13 idiopathic PAH patients [83], which was further extended to 66 patients with PH of varied etiology (39 PAH,18 Group 2 PH and nine operated chronic thromboembolic PH (CTEPH) [84].…”

Section: Pulmonary Artery Denervationmentioning

confidence: 99%

“…Over the 12-month follow-up period, there was one death (unrelated to PADN) and 11 PAH-related hospitalizations, which is considered to be an acceptable rate given the characteristics of the study population. Finally, although beyond the scope of this review, early in 2020, positive results from a randomized, single-blind clinical trial of PADN vs. sham procedure plus medical therapy with riociguat in CTEPH patients have been reported [86].…”

Section: Pulmonary Artery Denervationmentioning

confidence: 99%

“…Similarly, in a very recent experimental trial, ablation at certain PA sites with evoked heart rate responses, lead to disappearance of neural markers' expression [98]. In the CTEPH randomized clinical trial, a three-dimensional electroanatomical mapping system was used with remote magnetic navigation for the PADN procedures for the first time [86]. In any case, as long as the catheter applications are solely based on where sympathetic nerve fibers should lay (which is based, in turn, on anatomic descriptions from three to four cases [10,82]), it appears that the efficacy of the denervation procedures will largely depend on individual distribution and depth of the sympathetic/parasympathetic fibers and the size, thickness, and composition of the PA wall.…”

Section: Pulmonary Artery Denervationmentioning

confidence: 99%

“…In any case, as long as the catheter applications are solely based on where sympathetic nerve fibers should lay (which is based, in turn, on anatomic descriptions from three to four cases [10,82]), it appears that the efficacy of the denervation procedures will largely depend on individual distribution and depth of the sympathetic/parasympathetic fibers and the size, thickness, and composition of the PA wall. This limitation may be overcome by the recently described PA mapping strategies [86,98].…”

Section: Pulmonary Artery Denervationmentioning

confidence: 99%

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Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

García‐Lunar

Pereda

Ibáñez

et al. 2020

Cells

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The autonomic nervous system (ANS) and renin-angiotensin-aldosterone system (RAAS) are involved in many cardiovascular disorders, including pulmonary hypertension (PH). The current review focuses on the role of the ANS and RAAS activation in PH and updated evidence of potential therapies targeting both systems in this condition, particularly in Groups 1 and 2. State of the art knowledge in preclinical and clinical use of pharmacologic drugs (beta-blockers, beta-three adrenoceptor agonists, or renin-angiotensin-aldosterone signaling drugs) and invasive procedures, such as pulmonary artery denervation, is provided.

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Pulmonary artery denervation versus conventional therapies for PAH: a systematic review and updated network meta‐analysis

Wu,

Wang,

Zhang

et al. 2024

ESC Heart Failure

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AimsA recent guideline presented by the ESC Congress in 2022 had indicated a novel therapy targeted at pulmonary artery hypertension, known as pulmonary artery denervation (PADN), which get inspired from a laboratorial trial that could lowering the pulmonary artery pressure through the intervention on the animals. Our aim is to conduct a network meta‐analysis to compare the efficacy and safety of PADN from six aspects with the current conventional therapies.Methods and resultsAccording to the PRISMA guidance, databases including Ovid, ClinicalTrials.gov, Medline, Embase, and PubMed were searched from inception to 22 August 2023, along with a full assessment of the previous five meta‐analyses. Data were extracted and curated for Bayesian network meta‐analysis. The primary outcome was the change in the 6‐min walking distance (6MWD) from baseline with a secondary outcome called change in mean pulmonary artery pressure (mPAP) from baseline. The four safety outcomes included risk of clinical worsening, hospitalization, mortality and severe adverse events (SAEs). The comparison is structured on a contrast model based on 65 randomized controlled trials (RCTs) on PADN and the other conventional mainstream drugs. PADN had a better effect in improving 6MWD than Placebo (−77.76 m, 95% CI: −102.04 to −54.34 m), Macitentan (−65.32 m, 95% CI: −95.34 to −36.1 m), Bosentan (−64.5 m, 95% CI: −94.7 to −35.07 m), Iloprost (−62.66 m, 95% CI: −99.48 to −27.13 m), Oxygen (−62.42 m, 95% CI: −100.01 to −25.78 m), Treprostinil (−62.01 m, 95% CI: −89.04 to −35.61 m), Riociguat (−60.59 m, 95% CI: −86.11 to −35.98 m), Selexipag (−47.2 m, 95% CI: −85.61 to −10.19 m), Sildenafil (−44.92 m, 95% CI: −74.43 to −16.15 m), or Sitaxsentan (−39.53 m, 95% CI: −78.99 to −0.76 m). PADN had a better antihypertensive effect than placebo and showed statistical significant lower risks to induce clinical worsening and re‐hospitalization than treprostinil, riociguat, and placebo groups. No statistically significant difference in risk of mortality and severe adverse events was observed between PADN versus the other interventions.ConclusionsCompared with 16 types of conventional therapies and Placebo, PADN has advantage over nine single therapies and Placebo in improving 6MWD and appears to be better than two types of dual‐drug combined therapies while with no statistical significance. PADN shows a favourable antihypertensive effect on mPAP and has a lower risk to trigger clinical worsening or hospitalization, while its risk on mortality and severe adverse events is still inconclusive.

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

Cited by 52 publications

References 28 publications

Interventional and pharmacological management of chronic thromboembolic pulmonary hypertension

Interventional and pharmacological management of chronic thromboembolic pulmonary hypertension

Neurohormonal Modulation as a Therapeutic Target in Pulmonary Hypertension

Pulmonary artery denervation versus conventional therapies for PAH: a systematic review and updated network meta‐analysis

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