Key result
Pulmonary artery denervation using unipolar radiofrequency energy did not significantly decrease mean pulmonary artery pressure (12.1 vs 12.3 mm Hg; p=0.2) in an acute porcine model of PAH.
Why the study?
Questions remain regarding the perioperative effectiveness of pulmonary artery denervation (PADN) and the accuracy of target nerve damage in PAH.
Does pulmonary artery denervation decrease pulmonary artery pressure and damage perivascular nerve fibers in an acute porcine model of pulmonary arterial hypertension?
Does pulmonary artery denervation decrease pulmonary artery pressure and damage perivascular nerve fibers in an acute porcine model of pulmonary arterial hypertension?
Absolute Event Rate: 12.1% vs 12.3%
p-value: p=0.2
In an acute porcine model of PAH, pulmonary artery denervation using unipolar radiofrequency energy did not acutely reduce pulmonary artery pressure or cause immediate perivascular nerve fiber destruction.
Acute PADN shows no PAP reduction or blunted TXA2-PH induction in swine; leaves open delayed perivascular nerve effects for chronic study.
Introduction Pulmonary hemodynamics improvement after pulmonary artery denervation (PADN) was demonstrated in PAH. Questions arise regarding PADN perioperative effectiveness and the accuracy of the target nerves damage. The aim of the study was to evaluate whether PADN decreases pulmonary artery pressure (PAP) in acute thromboxane A2 (U46619)–induced PAH, and damages PA perivascular nerve fibers. Materials and methods 10 male Landrace swine (34.7±5.1 kg). In 6 swine acute reversible target mean PAP of 40 mm Hg was induced with synthetic thromboxane A2 infusion (U46619). Control group: 4 swine with PADN. Hemodynamics was assessed throughout the study, PAH modeling was done before and 20 min after PADN (radiofrequency energy, 40 Watts), followed by pathology and immunohistochemical studies. Results The mean number of RF applications was 17.5±3.6. Pulmonary embolism (PE) was observed after PADN in 3 swine with U46619 infusion, which were excluded. There was no differences in mPAP, PVR and U46619 dosage after PADN in PAH model (12.3±3.5 vs 12.1±1 mm Hg, p=0.2; 150.4±48.7 vs 129.2±64.1 dynes s cm–5; p=0.2; 24.9±3.3 vs 22.4±4.1 mcg; p=0.18; respectively). Similar hemodynamic results were observed in the control group after PADN (mPAP; p=0.3; PVR; p=0.58). S100 expression was evident in the majority of RFA PA species and in some species loss in tyrosine hydroxylase and M1 acetylcholine receptors expression was detected with no hemodynamic correlation. Conclusions PADN using an electrophysiological catheter with unipolar energy does not lead to an acute PA perivascular nerve fibers destruction and detectable mPAP changes in U46619-induced PAH. Delayed nerve damage might be attributable to PADN effects observed in previous studies. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant from the Ministry of Science and Higher Education of the Russian Federation (agreement #075-15-2020-800).
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Гончарова et al. (2021) studied Acute thromboxane A2-induced pulmonary arterial hypertension (n=10). Pulmonary artery denervation (PADN) vs. Baseline (before PADN) and control swine without PAH was evaluated on Mean pulmonary artery pressure (mPAP) (p=0.2). Pulmonary artery denervation using unipolar radiofrequency energy did not significantly decrease mean pulmonary artery pressure (12.1 vs 12.3 mm Hg; p=0.2) in an acute porcine model of PAH.
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