Pulmonary artery denervation for pulmonary hypertension: a systematic review and meta-analysis of clinical studies

Objective. To analyze the results of clinical studies on pulmonary artery denervation (PADN) for pulmonary hypertension treatment.

Design and methods. Study search was conducted in PubMed/Medline, Cochrane, Elibrary databases. The analysis included studies of surgical and transcatheter PADN. To assess the effectiveness of the PADN procedure, a mean pulmonary artery pressure (mPAP) and a 6-minute walk test distance (6-MWT) were selected. For each study, the mean change in mPAP and 6-MWT were calculated and included in the analysis.

Results. A total of 8 studies were analyzed: 4 randomized and 4 observational, 320 patients were included in the study, of which 222 patients underwent PADN. The etiology of pulmonary hypertension (PH) was different in each study and included patients with idiopathic PH, PH associated with heart failure, chronic thromboembolic PH. According to the combined data analysis, mPAP decreased in all studies, and the overall change in mPAP was –8,59 [95 % confidence interval (CI) –10,96; –6,23]. The average increase in 6-MWT among studies was 60,00 [95 % CI 35,74; 84,27].

Conclusions. Despite serious limitations (a small number of studies and subjects enrolled, non-randomized design of a half of the studies, high heterogeneity of data), this analysis demonstrated the association of the PADN procedure with a decrease in pulmonary artery pressure and prolongation of the 6-minute walking distance in patients with PH of various etiologies.

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