Simplicity Denervation System for Pulmonary Artery Denervation in Patients with Residual Pulmonary Hypertension after Pulmonary Thromboembolism and Surgical Thrombectomy

Руденко, Б. А.; Shanoyan, А. S.; Драпкина, О. М.; Гаврилова, Н. Е.; Beregovskaya, S. A.; Ахадова, А Ш; Фещенко, Д. А.; Шукуров, Ф. Б.; Vlasov, V.; Boytsov, S.; Дземешкевич, С Л; Frolova, Yu V; Edemsky, A. G.

doi:10.26502/fccm.92920024

Cited by 5 publications

(6 citation statements)

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“…A total of 188 articles were retrieved and 8 studies were nally included, which are all prospective studies and involve a total of 213 patients [13,[16][17][18][19][20][21][22]. All patients were treated with PADN and followed up for 1-12 months.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…Most studies did not observe the occurrence of surgery-related adverse events, such as pulmonary artery perforation and the formation of dissection aneurysm or acute thrombus [13,16,17,20]. Zhang et al con rmed that compared with the sildena l group, the improvement of mPAP and 6MWD in the PADN group was more obvious, and the clinical worsening was less frequent [22].…”

Section: Discussionmentioning

confidence: 99%

“…The results showed that after PADN, the mPAP decreased signi cantly (MD -12.51, 95% CI -17.74 to -7.27, P 0.00001) (mmHg) ( Figure 3A). 8 studies (n = 213) for meta-analysis of PVR [13,[16][17][18][19][20][21][22]. Meta-analysis results showed that there was signi cant heterogeneity between the literatures (P <0.00001, I 2 = 93%), which was analyzed using a random effects model.…”

Section: Hemodynamic Parametersmentioning

confidence: 99%

“…5 studies (n = 124) reported 6MWD [16,17,[19][20][21][22]. There was obvious heterogeneity in these studies (P 0.00001 ; I 2 = 85%) and the random effects model was conducted.…”

Section: Quality Of Lifementioning

confidence: 99%

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

Zuo

Xiao

Xie

et al. 2020

Preprint

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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.

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Hemodynamic Parametersmentioning

confidence: 99%

“…5 studies (n = 124) reported 6MWD [16,17,[19][20][21][22]. There was obvious heterogeneity in these studies (P 0.00001 ; I 2 = 85%) and the random effects model was conducted.…”

Section: Quality Of Lifementioning

confidence: 99%

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

Zuo

Xiao

Xie

et al. 2020

Preprint

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“…Circular ablation of the PA trunk and its main branches with an intention to reduce PA pressure is a more empirical approach. Nevertheless, despite the variability in the number and location of the ablation points proposed by different authors, as well as variable radiofrequency ablation power and duration of each application, and even energy source (radiofrequency, ultrasound), researchers report on positive effects of PA denervation in a significant number of patients with different types of pulmonary hypertension [10,[23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Electrical Stimulation‐Guided Approach to Pulmonary Artery Catheter Ablation in Patients with Idiopathic Pulmonary Arterial Hypertension: A Pilot Feasibility Study with a 12‐Month Follow‐Up

Гончарова

Моисеева

Leandro

et al. 2020

BioMed Research International

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Background. Recently, transcatheter pulmonary artery (PA) ablation aiming at sympathetic denervation has been proposed in pulmonary arterial hypertension (PAH). This pilot feasibility study aimed to assess the feasibility of selective radiofrequency PA ablation based on response to high-frequency stimulation mapping. Methods. The study comprised 3 female patients with idiopathic PAH (IPAH). The following reactions to PA stimulation were noted and marked by color points on the three-dimensional map: sinus bradycardia (heart rate decrease ≥15%), tachycardia (heart rate increase ≥15%), phrenic nerve capture, and cough. Since the most appropriate ablation strategy was unknown, two approaches were suggested, according to stimulation results: ablation at points with any heart rate response (either bradycardia or tachycardia)—this approach was applied in patient #1 (IPAH long-term responder to calcium channel blockers); segmental ablation at points with no response and with tachycardia response (one IPAH long-term responder to calcium channel blockers patient and one–IPAH with negative vasoreactive testing). Hemodynamic measurements were performed before and after denervation. Follow-up visits were scheduled at 6 and 12 months. Results. Six-months follow-up was uneventful for patients #1 and 3; patient #2 had one syncope and reduced 6-minute walk test distance and peak VO2 consumption. At 12 months, there was a normalization of mean PA pressure and pulmonary vascular resistance (PVR) in patient #1. Patient #2 had no change in PA pressure and PVR at 12 months. Patient #3 remained in II functional class; however, there was an increase in mean PA pressure and loss of vasoreactivity. Conclusions. Electrical high-frequency stimulation of the PA identifies several types of evoked reactions: heart rate slowing, acceleration, phrenic nerve capture, and cough. The improvement in clinical and hemodynamic parameters following targeted PA ablation in the IPAH patient with positive vasoreactive testing should be confirmed in larger studies.

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Inflow from a Cardiopulmonary Assist System to the Pulmonary Artery and Its Implications for Local Hemodynamics—a Computational Fluid Dynamics Study

Hugenroth

Krooß

Hima

et al. 2023

J. of Cardiovasc. Trans. Res.

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When returning blood to the pulmonary artery (PA), the inflow jet interferes with local hemodynamics. We investigated the consequences for several connection scenarios using transient computational fluid dynamics simulations. The PA was derived from CT data. Three aspects were varied: graft flow rate, anastomosis location, and inflow jet path length from anastomosis site to impingement on the PA wall. Lateral anastomosis locations caused abnormal flow distribution between the left and right PA. The central location provided near-physiological distribution but induced higher wall shear stress (WSS). All effects were most pronounced at high graft flows. A central location is beneficial regarding flow distribution, but the resulting high WSS might promote detachment of local thromboembolisms or influence the autonomic nervous innervation. Lateral locations, depending on jet path length, result in lower WSS at the cost of an unfavorable flow distribution that could promote pulmonary vasculature changes. Case-specific decisions and further research are necessary. Graphical Abstract

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Simplicity Denervation System for Pulmonary Artery Denervation in Patients with Residual Pulmonary Hypertension after Pulmonary Thromboembolism and Surgical Thrombectomy

Cited by 5 publications

References 0 publications

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

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

Electrical Stimulation‐Guided Approach to Pulmonary Artery Catheter Ablation in Patients with Idiopathic Pulmonary Arterial Hypertension: A Pilot Feasibility Study with a 12‐Month Follow‐Up

Inflow from a Cardiopulmonary Assist System to the Pulmonary Artery and Its Implications for Local Hemodynamics—a Computational Fluid Dynamics Study

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