Pulmonary artery denervation in pulmonary hypertension: A comprehensive meta-analysis

Pulmonary hypertension (PH) is a serious condition characterized by increased pulmonary vascular resistance and elevated pulmonary artery pressure, leading to right heart failure and high mortality rates. Conventional treatments primarily include vasodilators, which provide symptomatic relief but do not effectively reverse the underlying vascular pathology. Pulmonary artery denervation (PADN) has emerged as a novel therapeutic approach targeting the sympathetic nervous system's role in PH.

This meta-analysis aims to evaluate the impact of PADN on hemodynamic parameters, including mean right atrial pressure (mRAP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR), in patients with pulmonary hypertension.

A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library, covering studies published until September 2023. The inclusion criteria focused on studies involving human subjects with PH undergoing PADN, reporting relevant hemodynamic outcomes. Data from 14 studies were analyzed using Review Manager 5.3. Continuous outcomes were pooled using mean differences (MD) with 95 % confidence intervals (CI), and the random effects model was applied where significant heterogeneity was detected.

The meta-analysis included data from 14 studies comprising 372 patients. PADN resulted in significant reductions in mRAP (MD -1.71 mmHg, 95 % CI -2.34 to -1.08, p < 0.00001, I² = 15 %), mPAP (MD -10.64 mmHg, 95 % CI -14.33 to -6.95, p < 0.00001, I² = 84 %), and PVR (MD -4.69 Wood units, 95 % CI -6.55 to -2.83, p < 0.00001, I² = 93 %). Additionally, there was a significant increase in cardiac output (CO) (MD 0.44 L/min, 95 % CI 0.25 to 0.62, p < 0.00001, I² = 71 %) and 6-min walk distance (6MWD) (MD 62.4 m, 95 % CI 20.99 to 103.81, p = 0.003, I² = 94 %).

PADN shows promise as a therapeutic intervention for PH, significantly improving key hemodynamic parameters and exercise capacity. However, the substantial heterogeneity observed among studies highlights the need for standardized procedures and further high-quality, long-term randomized controlled trials to validate these findings and refine patient selection criteria. The results support the potential of PADN to enhance current treatment strategies for pulmonary hypertension.