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Pulmonary artery denervation for improving outcome in patients with residual pulmonary hypertension after pulmonary thromboendarterectomy. Evaluation of results 12 months after PADN.

Session CTEPH: Catheter-directed and surgical therapy

Speaker Natalya Novikova

Event : ESC Congress 2017

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Hypertension
  • Session type : Moderated Posters

Authors : N Novikova (Novosibirsk,RU), A Cherniavskiy (Novosibirsk,RU), E Pokushalov (Novosibirsk,RU), A Edemskiy (Novosibirsk,RU), A Romanov (Novosibirsk,RU)

Authors:
N. Novikova1 , A. Cherniavskiy1 , E. Pokushalov1 , A. Edemskiy1 , A. Romanov1 , 1State Research Institute of Circulation Pathology - Novosibirsk - Russian Federation ,

Topic(s):
Chronic pulmonary hypertension

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 835

Aim: To evaluate efficacy and safety of pulmonary artery radiofrequency denervation (PADN) for pulmonary artery (PA) pressure decrease in patients with residual pulmonary hypertension after pulmonary thromboendarterectomy. 12 months after PADN.

Methods: PADN was performed in 20 patients with residual pulmonary hypertension after pulmonary thromboendarterectomy. Indication for PADN was mean PA pressure level >25 mm Hg with absence of proximal PA lesion according to CT scan and angiopulmonography. For PADN efficacy assessment with V/Q-scanning, echocardiography, right heart catheterization and 6-minute walking distance test were performed. During preoperative evaluation subsegmental PA perfusion defects were revealed in all patients. PADN was performed using of nonfluoroscopic 3-D navigation system with standard catheter for radiofrequency ablation. Swan-Ganz catheter was used for intraoperative hemodynamic measurements. All Patients were followed up during 30 days and 12 months after procedure.

Results: There were no complications or death during the procedure and before discharge. Mean procedure time was 105 [93; 120] min. After PADN the mean PA pressure decrease from 37,3 mm Hg [29; 38] to 24,6 [17; 30] mm Hg (p=0,011) and pulmonary vascular resistance from 672 [387; 566] dyn*sec*cm-5 to 386 [155; 449] dyn*sec*cm-5 (p=0,017). 12 months after the PADN, the mean PA pressure was 21.3 [15; 29] mm Hg (p=0,015) and pulmonary vascular resistance was 313 [124; 410] dyn*sec*cm-5 (p=0,021). 6-minute walking distance test was 492 [385; 675] m; p=0,0214, respectively 12 months later.

There were no significant increase of cardiac output compared to baseline data (3,4 [3,2; 3,4] l/min vs 3,6 [3,3; 4,1] l/min; p=0,317. All patients noticed reduction of dyspnea and improving exercise tolerance during the year after PADN.

Conclusion: Our experience and results observations of patients during the year after PADN demonstrated, that PADN in patients with residual pulmonary hypertension after pulmonary thromboendarterctomy is safe and effective during the year it terms of pulmonary PA decrease. Long-term follow up and further studies are needed to assess the role of of PADN in the treatment of these category of patients.

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