Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.
Department of Cardiology, Hunan Children's Hospital, Changsha, Hunan, People's Republic of China.
Braz J Cardiovasc Surg. 2022 Aug 16;37(4):554-565. doi: 10.21470/1678-9741-2020-0533.
Pulmonary artery denervation (PADN) can reduce the sympathetic nervous system (SNS) activity, reduce pulmonary artery pressure (PAP), and improve the quality of life in patients with pulmonary hypertension (PH). We conducted a systematic meta-analysis of the effectiveness of PADN in the treatment of PH patients.
This is a comprehensive literature search including all public clinical trials investigating the effects of PADN on PH. Outcomes were mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), cardiac output (CO), right ventricular (RV) Tei index, 6-minute walk distance (6MWD), and New York Heart Association (NYHA) cardiac function grading.
A total of eight clinical studies with 213 PH patients who underwent PADN were included. Meta-analysis showed that after PADN, mPAP (mean difference [] -12.51, 95% confidence interval [CI] -17.74 to -7.27, P<0.00001) (mmHg) and PVR ( -5.17, 95% CI -7.70 to -2.65, P<0.0001) (Wood unit) decreased significantly, CO ( 0.59, 95% CI 0.32 to 0.86, P<0.0001) (L/min) and 6MWD ( 107.75, 95% CI 65.64 to 149.86, P<0.00001) (meter) increased significantly, and RV Tei index ( -0.05, 95% CI -0.28 to 0.17, P=0.63) did not change significantly. Also after PADN, the proportion of NYHA cardiac function grading (risk ratio 0.23, 95% CI 0.14 to 0.37, P<0.00001) III and IV decreased significantly.
This meta-analysis supports PADN as a potential new treatment for PH. Further high-quality randomized controlled studies are needed.
肺动脉去神经支配（PADN）可以降低交感神经系统（SNS）的活性，降低肺动脉压（PAP），提高肺动脉高压（PH）患者的生活质量。我们对 PADN 治疗 PH 患者的疗效进行了系统的荟萃分析。
这是一项全面的文献检索，包括所有关于 PADN 对 PH 影响的公开临床试验。结果是平均肺动脉压（mPAP）、肺血管阻力（PVR）、心输出量（CO）、右心室（RV）Tei 指数、6 分钟步行距离（6MWD）和纽约心脏协会（NYHA）心功能分级。
共纳入 8 项临床研究，共 213 例 PH 患者行 PADN。荟萃分析显示，PADN 后 mPAP（均值差 [] -12.51，95%置信区间 [CI] -17.74 至 -7.27，P<0.00001）（mmHg）和 PVR（ -5.17，95% CI -7.70 至 -2.65，P<0.0001）（Wood 单位）显著降低，CO（ 0.59，95% CI 0.32 至 0.86，P<0.0001）（L/min）和 6MWD（ 107.75，95% CI 65.64 至 149.86，P<0.00001）（米）显著增加，RV Tei 指数（ -0.05，95% CI -0.28 至 0.17，P=0.63）无显著变化。此外，PADN 后 NYHA 心功能分级（风险比 0.23，95% CI 0.14 至 0.37，P<0.00001）III 和 IV 级的比例也显著降低。
这项荟萃分析支持 PADN 作为 PH 的一种潜在新的治疗方法。需要进一步进行高质量的随机对照研究。
