Pulmonary Artery Denervation to Treat Pulmonary Arterial Hypertension The Single-Center, Prospective, First-in-Man PADN-1 Study (First-in-Man Pulmonary Artery Denervation for Treatment of Pulmonary Artery Hypertension)
Pulmonary Artery Denervation to Treat Pulmonary Arterial Hypertension The Single-Center, Prospective, First-in-Man PADN-1 Study (First-in-Man Pulmonary Artery Denervation for Treatment of Pulmonary Artery Hypertension)
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DOI：
10.1016/j.jacc.2013.05.075
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发表时间：
2013-09-17
影响因子：
24
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
作者：
Chen, Shao-Liang;Zhang, Feng-Fu;Stone, Gregg W.
目的探讨肺动脉（PA）去神经支配（PADN）治疗药物治疗无效的特发性PA高血压（IPAH）的安全性和有效性。我们以前证明，PADN完全废除了实验升高PA压力反应闭塞的左叶间PA。方法共21例IPAH患者，13例接受PADN程序，和其他8例拒绝PADN程序被分配到对照组。在主PA的分叉处以及右PA和左PA的开口处进行PADN。进行了系列超声心动图、右心导管插入术和6分钟步行试验（6 MWT）。结果与对照组比较，PADN组术后3个月平均肺动脉压（PAP）明显降低，术后3个月平均肺动脉压（PAP）、三尖瓣位移指数（Tei）、6 MWT均明显下降（从55 +/- 5 mm Hg到36 +/- 5 mm Hg，p < 0.01），6 MWT显著改善（从324 +/- 21 m到491 +/- 38 m，p < 0.006）和Tei指数（从0.7 +/- 0.04到0.50 +/- 0.04，结论我们首次报道了PADN对药物治疗无效的IPAH患者的功能和血流动力学的影响。需要进一步的随机研究来证实PADN的疗效。（首次人体肺动脉去神经术治疗肺动脉高压[PADN-1]研究; chiCTR-ONC-12002085）（C）2013年美国心脏病学会基金会
Objectives This study was designed to test the safety and efficacy of pulmonary artery (PA) denervation (PADN) for patients with idiopathic PA hypertension (IPAH) not responding optimally to medical therapy.Background Baroreceptors and sympathetic nerve fibers are localized in or near the bifurcation area of the main PA. We previously demonstrated that PADN completely abolished the experimentally elevated PA pressure responses to occlusion of the left interlobar PA.Methods Of a total of 21 patients with IPAH, 13 patients received the PADN procedure, and the other 8 patients who refused the PADN procedure were assigned to the control group. PADN was performed at the bifurcation of the main PA, and at the ostial right and left PA. Serial echocardiography, right heart catheterization, and a 6-min walk test (6MWT) were performed. The primary endpoints were the change of PA pressure (PAP), tricuspid excursion (Tei) index, and 6MWT at 3 months follow-up.Results Compared with the control group, at 3 months follow-up, the patients who underwent the PADN procedure showed significant reduction of mean PAP (from 55 +/- 5 mm Hg to 36 +/- 5 mm Hg, p < 0.01), and significant improvement of the 6MWT (from 324 +/- 21 m to 491 +/- 38 m, p < 0.006) and of the Tei index (from 0.7 +/- 0.04 to 0.50 +/- 0.04, p < 0.001).Conclusions We report for the first time the effect of PADN on functional capacity and hemodynamics in patients with IPAH not responding optimally to medical therapy. Further randomized study is required to confirm the efficacy of PADN. (First-in-Man Pulmonary Artery Denervation for Treatment of Pulmonary Artery Hypertension [PADN-1] study; chiCTR-ONC-12002085) (C) 2013 by the American College of Cardiology Foundation