Key result
Pulmonary artery denervation added to mitral valve surgery and the Maze IV procedure significantly reduced secondary pulmonary hypertension (P=0.018) and improved sinus rhythm restoration (P=0.022).
Why the study?
The study evaluated the impact of sympathetic pulmonary artery denervation on outcomes of surgical treatment in patients with mitral valve dysfunction complicated by AF and severe pulmonary hypertension.
Does radiofrequency pulmonary artery denervation improve pulmonary hypertension and sinus rhythm restoration in patients with mitral valve dysfunction, atrial fibrillation, and severe pulmonary hypertension undergoing mitral valve surgery and Maze IV?
Cohort (n=140)
Does radiofrequency pulmonary artery denervation improve pulmonary hypertension and sinus rhythm restoration in patients with mitral valve dysfunction, atrial fibrillation, and severe pulmonary hypertension undergoing mitral valve surgery and Maze IV?
p-value: p=0.018
Adding pulmonary artery denervation to mitral valve surgery and the Maze IV procedure may safely reduce pulmonary hypertension and improve sinus rhythm restoration in patients with severe secondary pulmonary hypertension.
May support adjunctive PADN in mitral surgery with severe PH; leaves open randomized confirmation of benefits.
Background: The aim of this study was to evaluate the impact of sympathetic denervation of the pulmonary trunk and main pulmonary arteries on outcomes of surgical treatment in patients with mitral valve dysfunction, complicated by atrial fibrillation (AF) and severe Pulmonary Hypertension (PH). Method: Between September 2013 and July 2019, 140 patients with mitral valve dysfunction, concomitant AF and severe PH (mean pulmonary arterial pressure, MPAP, greater than 40 mmHg) who underwent cardiac surgery were analyzed. In the Denervation group, 51 patients underwent mitral valve surgery, biatrial Maze IV procedure and radiofrequency denervation of trunk and both main pulmonary arteries (pulmonary artery denervation, PADN). In the control group, 89 patients underwent the same surgery stages without PADN procedure. Results: Circular pulmonary artery denervation (PADN) contributes to a significant reduction in secondary PH (p = 0.018), reverse remodeling of the heart chambers, in particular the left atrium (p = 0.01), is an effective and safe method, and improves the results of the Maze IV procedure (p = 0.022) due to the sinus rhythm restoration, in patients with mitral valve dysfunction, complicated by AF and PH. Conclusions: Circulatory PADN additional to mitral valve surgery and Maze procedure represents a safe and effective treatment method for patients with mitral valve dysfunction, complicated by AF and severe PH. It is necessary to continue the study of this technique involving a larger number of patients, to analyze long-term outcomes and use this technique in patients with non-valvular causes of secondary PH.
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Vadim et al. (2020) conducted a cohort in Mitral valve dysfunction complicated by atrial fibrillation and severe pulmonary hypertension (n=140). Radiofrequency pulmonary artery denervation (PADN) combined with mitral valve surgery and Maze IV procedure vs. Mitral valve surgery and Maze IV procedure without PADN was evaluated on Reduction in secondary pulmonary hypertension (p=0.018). Pulmonary artery denervation added to mitral valve surgery and the Maze IV procedure significantly reduced secondary pulmonary hypertension (P=0.018) and improved sinus rhythm restoration (P=0.022).
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