P2617Pulmonary artery denervation as a new method of non-farmacological treatment of residual pulmonary hypertention after pulmonary endarterectomy

Abstract

Objective: The true incidence of chronic thromboembolic pulmonary hypertension (CTEPH) is still remains unknown. Pulmonary endarterectomy (PEA) is the first treatment of choice in patients with CTEPH. Residual pulmonary hypertension (RPH) occurs after PEA in 10-40% of cases. We assessed the safety and efficiency of pulmonary artery denervation (PADN) for treatment of patients with RPH after pulmonary endarterectomy (PEA). Methods: A pilot prospective observational multicenter study was performed between 2015 and 2017. 26 patients with RPH after PEA underwent PADN. The mean age of the patients was 39 (26; 52) years. The median delay between PEA and PADN was 4.5 years (1; 8). The main criteria of RPH was mean pulmonary artery pressure more than 25 mm Hg. Denervation was performed by radiofrequent ablation of the nerve plexus and ganglia located in pulmonary bifurcation area with the usual electrophysiological catheter and a non-fluorography 3D navigation. All patients before procedure and after 12-month follow up underwent the following examinations: echocardiography, perfusion and ventilation lung scintigraphy, pulmonary angiography, right heart catheterization and 6-minute walking distance test. Results: There were no mortality and other adverse events during the PADN procedure and follow up. The mean operation time was 103 (92; 119) minutes. In 12 months after PADN a significant decrease of pulmonary vascular resistance from 600 (387; 667) dyn×sec×sm-5 to 351 (156; 450) dyn×sec×sm-5 (p\{{\textbackslash}textless}0,01), mean pulmonary artery pressure from 38 (29; 42) mm Hg to 26 (22; 35) mm Hg (p\{{\textbackslash}textless}0,01) and increase in the 6MWT from 369 meters to 454 meters (p\{{\textbackslash}textless}0,001) were observed. All patients subjectively noted decrease in dyspnea and increased tolerance to exertion. Conclusion: Our pilot study has shown safety and the efficacy of PADN in patients with RPH after PEA as during procedure and as after 12-month follow up. However, for confirmation of these results a multicenter randomized study is required.