The progress of pulmonary artery denervation

Xie, Yonghui; Liu, Na; Xiao, Zhenghui; Yang, Fang; Zeng, Yunhong; Zhou, Yang; Xia, Yuanxi; Chen, Zhi; Xiao, Yunbin

doi:10.5603/cj.a2020.0186

Cited by 5 publications

(3 citation statements)

References 45 publications

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“…Numerous clinical and animal trials have demonstrated the effectiveness of PADN in treating PH 19–25 . These findings have been comprehensively reviewed 26,27 . However, the precise mechanisms underlying the effects of PADN remain a topic of ongoing debate.…”

Section: Non‐pharmacological Neuromodulation Therapymentioning

confidence: 99%

“… 19 , 20 , 21 , 22 , 23 , 24 , 25 These findings have been comprehensively reviewed. 26 , 27 However, the precise mechanisms underlying the effects of PADN remain a topic of ongoing debate. In a study by Zhou et al ., 28 a canine model of PAH was established using dehydrogenized monocrotaline (DHMC), and the results indicated that PADN had the capacity to partially alleviate pulmonary vascular remodelling.…”

Section: Non‐pharmacological Neuromodulation Therapymentioning

confidence: 99%

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Autonomic nervous modulation: early treatment for pulmonary artery hypertension

Xueyuan,

Yanping,

Jiaoqiong

et al. 2023

ESC Heart Failure

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Pulmonary artery hypertension (PAH) is a chronic vascular disease defined by the elevation of pulmonary vascular resistance and mean pulmonary artery pressure, which arises due to pulmonary vascular remodelling. Prior research has already established a link between the autonomic nervous system (ANS) and PAH. Therefore, the rebalancing of the ANS offers a promising approach for the treatment of PAH. The process of rebalancing involves two key aspects: inhibiting an overactive sympathetic nervous system and fortifying the impaired parasympathetic nervous system through pharmacological or interventional procedures. However, the understanding of the precise mechanisms involved in neuromodulation, whether achieved through medication or intervention, remains insufficient. This limited understanding hinders our ability to determine the appropriate timing and scope of such treatment. This review aims to integrate the findings from clinical and mechanistic studies on ANS rebalancing as a treatment approach for PAH, with the ultimate goal of identifying a path to enhance the safety and efficacy of neuromodulation therapy and improve the prognosis of PAH.

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Section: Non‐pharmacological Neuromodulation Therapymentioning

confidence: 99%

Section: Non‐pharmacological Neuromodulation Therapymentioning

confidence: 99%

Autonomic nervous modulation: early treatment for pulmonary artery hypertension

Xueyuan,

Yanping,

Jiaoqiong

et al. 2023

ESC Heart Failure

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“…и улучшении показателей теста с 6-минутной ходьбой, значительно большем, чем при консервативной терапии. Эффект PADN достигался путем симпатической денервации легочного ствола и легочных артерий за счет демиелинизации нервных волокон симпатического отдела вегетативной нервной системы, что приводило к расслаблению гладкомышечных волокон в стенке сосудов малого круга кровообращения, и, как следствие, к снижению давления в последнем [14].…”

Section: Abstract: Simulation Training Pulmonary Arteries Denervation...unclassified

The Development of Anatomic Heart and Major Vessels Model for Operation of Circular Denervation of the Trunk and Mouths Pulmonary Arteries (PADN) Simulation

Никольский,

Трофимов,

Родионов

et al. 2023

Хирургия. Восточная Европа

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Цель. Создание анатомической модели сердца человека с реалистичной топографией магистральных сосудистых структур для отработки технологии эндоваскулярной и «открытой» хирургической процедуры циркулярной денервации ствола и устьев легочных артерий (pulmonary artery denervation – PADN). Материалы и методы. 3D-модели сердца могут использоваться для создания пространственного представления о топографии структур сердца и отработки хирургических манипуляций сердечно-сосудистыми хирургами и интервенционными кардиологами. Авторами разработан симулятор сердца и магистральных венозных сосудов человека. Модель создавалась по данным, полученным с помощью компьютерной томографии сердца пациента с гипертрофической кардиомиопатией и легочной гипертензией (ЛГ). С помощью симулятора была смоделирована операция PADN. Топографическое расположение ствола и бифуркации легочной артерии (ЛА), эластичные и прозрачные стенки сосудов позволили осуществить «открытую» процедуру денервации ЛА с применением зажима-аблятора. Эндоваскулярная технология выполнения PADN была отработана на симуляторе сердца в режиме флуороскопического контроля в условиях рентген-операционной. Радиочастотная абляция выполнялась в условиях погружения симулятора сердца в водно-солевой раствор, имитирующий естественную проводимость крови и тканей организма человека, точность и длительность аппликаций радиочастотного воздействия контролировалась навигационным модулем системы Carto и отображалась соответственно на анатомической карте ЛА в режиме реального времени. Результаты. Создана 3D-модель сердца, позволяющая отрабатывать процедуру PADN как открытым способом, так и эндоваскулярно. В результате обучения хирургической операции PADN на симуляторе время ее выполнения сократилось с 12,2±2,5 мин. до 5,5±1,5 мин. Благодаря отработке эндоваскулярного метода на анатомической модели, время выполнения процедуры под контролем флуороскопии сократилось с 37,2±6,7 мин. до 18,1±1,8 мин. Время выполнения процедуры в условиях навигационного картирования сократилось с 28,3±2,2 мин. до 15,5±3,0 мин. Заключение. Предложенная авторами анатомическая модель сердца CorView позволила отработать как хирургический, так и эндоваскулярный способы проведения PADN. Последний выполнялся как под визуальным, так и под флуороскопическим контролем. Исследование показало, что даже однократное выполнение манипуляции на модели сердца приводило к снижению затрачиваемого на выполнение процедуры времени, что в совокупности демонстрирует эффективность данного симулятора для обучения операции PADN. Purpose. To develop an anatomic heart model with realistic major vessels’ topography for practicing of endovascular and "open" surgical procedures for circular denervation of the trunk and orifices pulmonary arteries (Pulmonary artery denervation – PADN). Materials and methods. 3D heart models can be used by cardiac surgeons and interventional cardiologists to create a spatial representation of heart structures’ topography and practice surgical manipulations. The authors have developed a human heart and major vessels simulator. The model was created based on data obtained using computed tomography of the heart of a patient with hypertrophic cardiomyopathy and pulmonary hypertension. PADN procedure was performed with the help of the simulator. The topographic location of the trunk and bifurcation of the pulmonary artery, elastic and transparent vessel walls made it possible to carry out an "open" surgical PADN using an ablator clamp. Endovascular PADN was worked out with the help of simulator with the fluoroscopic control in an x-ray operation rooms. Radiofrequency ablation was performed in a water-salt solution simulating the natural conductivity of blood and tissues of the human body. The accuracy and duration of applications of radiofrequency exposure was controlled by the navigation module of the "Carto" system and displayed accordingly on the anatomical map of the pulmonary artery in real time. Results. A 3D model of the heart has been created. It allows practicing the PADN procedure both in an open way and endovascular way. As a result of PADN surgical operation training on a simulator, its execution time was reduced from 12.2±2.5 min to 5.5±1.5 min. The time of the endovascular PADN procedure under the control of fluoroscopy was reduced from 37.2±6.7 minutes to 18.1±1.8 minutes due to training with the heart model. The procedure execution time in the conditions of navigation mapping decreased from 28.3±2.2 min. to 15.5±3.0 min. Conclusion. The anatomical heart model CorView makes it possible to work out both surgical and endovascular methods of PADN. The latter was performed under both visual and fluoroscopic control. The study has shown, that even a single PADN training on a heart model has led to a decrease in the time spent on the procedure, which demonstrates the effectiveness of this simulator for teaching PADN procedure.

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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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The progress of pulmonary artery denervation

Cited by 5 publications

References 45 publications

Autonomic nervous modulation: early treatment for pulmonary artery hypertension

Autonomic nervous modulation: early treatment for pulmonary artery hypertension

The Development of Anatomic Heart and Major Vessels Model for Operation of Circular Denervation of the Trunk and Mouths Pulmonary Arteries (PADN) Simulation

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

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