AUTHOR=Davies Mark G. , Miserlis Dimitrios , Hart Joseph P. 

TITLE=Current status of pulmonary artery denervation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.972256

DOI=10.3389/fcvm.2022.972256

ISSN=2297-055X

ABSTRACT=Pulmonary hypertension is a progressive disease with poor long-term prognosis
and high mortality. Pulmonary artery denervation (PADN) is emerging as a potential novel therapy for this condition. The basis of pursuing a sympathetic denervation strategy has its origins in a body of experimental translation work that have demonstrated that denervation can reduce sympathetic nerve activity in various animal models.  This reduction in pulmonary sympathetic nerve activity is associated with a reduction in pathological pulmonary hemodynamics in response to mechanical, pharmacological  and toxicologically induced pulmonary hypertension.  The commonest method of PADN is catheter directed thermal ablation. Since 2014, there have been 12 reports on the role of PADN in 490 humans with pulmonary hypertension (311:179; treated : control).  Of these, 6 are case series, 3 are randomized trials and 3 are case reports.  Ten of the studies used percutaneous PADN techniques and 2 combined PADN with mitral and/or left atrial surgery. PADN treatment has a low mortality and morbidity and is associated with an improved the 6-minute walking distance, a reduction in both mean pulmonary artery pressure and pulmonary vascular resistance, and an improvement in cardiac output.  These improved outcomes were see over a median follow-up of 12 months (range 2-46 months).  A recent meta-analysis of human trials also supports the effectiveness of PADN in carefully selected patients.  Based on the current literature, pulmonary artery denervation can be effective in selected patients with pulmonary hypertension. Additional randomized clinical trials against best medical therapy are required.