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Effect of pulmonary artery denervation in postcapillary pulmonary hypertension: results of a randomized controlled translational study

2019; Springer Nature; Volume: 114; Issue: 2 Linguagem: Inglês

10.1007/s00395-018-0714-x

1435-1803

Inés García‐Lunar, Daniel Pereda, Evelyn Santiago, Núria Solanes, Jorge Nuche, María Ascaso, Joaquim Bobí, Federico Sierra, Ana Paula Dantas, C Galan, Rodolfo San Antonio, Damian Sánchez‐Quintana, Javier Sánchez‐González, Joan Albert Barberà, Montserrat Rigol, Valentı́n Fuster, Borja Ibáñez, Manel Sabaté, Ana García‐Álvarez,

Cardiovascular Function and Risk Factors

There is scarce evidence for pulmonary artery denervation (PADN) as a potential treatment for chronic postcapillary pulmonary hypertension (PH). We aimed to perform a proof-of-concept of PADN in a translational model of chronic PH. Nineteen pigs with chronic postcapillary PH (secondary to pulmonary vein banding) were randomized to surgical-PADN (using bipolar radiofrequency clamps) or sham procedure. Additionally, 6 healthy animals underwent percutaneous-PADN to compare the pulmonary artery (PA) lesion generated with both approaches. In the surgical-PADN arm, hemodynamic evaluation and cardiac magnetic resonance (CMR) were performed at baseline and at 2 and 3-month follow-up. Histological assessment was carried out at the completion of the protocol. Eighteen pigs (6 following surgical-PADN, 6 sham and 6 percutaneous-PADN) completed the protocol. A complete transmural PA lesion was demonstrated using surgical clamps, whereas only focal damage to adventitial fibers was observed after percutaneous-PADN. In the surgical-PADN arm, the hemodynamic profile did not significantly differ between groups neither at baseline [mean pulmonary artery pressure (mPAP) median values of 32.0 vs. 27.5 mmHg, P = 0.394 and indexed pulmonary vascular resistance (iPVR) 5.9 vs. 4.7 WU m2, P = 0.394 for PADN/sham groups, respectively] nor at any follow-up (mPAP of 35.0 vs. 35.0 mmHg, P = 0.236 and iPVR of 8.3 vs. 6.7 WU m2, P = 0.477 at third month in PADN/sham groups, respectively). Surgical-PADN was not associated with any benefit in RV anatomy or function on CMR/histology. In a large-animal model of chronic postcapillary PH, transmural PADN with surgical clamps was associated with a neutral pulmonary hemodynamic effect.