Cryoablation Pulmonary Artery Denervation for the Treatment of Combined Post-Capillary Pulmonary Hypertension Caused Be Left Heart Diseases

Introduction: Pulmonary artery denervation is rapidly evolving method for treatment of pulmonary hypertension. The purpose of our first-in-man study is to assess the effectiveness of cryoablation for pulmonary artery denervation in patients with pulmonary hypertension secondary to a left heart disease. Methods: 24 patients with combined post capillary pulmonary artery hypertension (mPAP ≥25 mm Hg, PCWP >15 mm Hg, PVR >3.0 WU or DPG ≥ 7 mm Hg (or both) were included in the study. The effectiveness of cryodenervation was assessed according to the changes in clinical status, functional capacity and pulmonary hemodynamics during 12-month follow-up. Results: There were no complications during and immediately following the cryoablation procedure. There was significant increase in functional capacity measured by 6MWT: 319 ± 18 m before cryodenervation and 502 ± 22 m (p<0.05) at 12 months follow-up. The N-terminal pro–brain natriuretic peptide value decreased from 2928 ± 223 ng/mL at baseline to 989 ± 67 ng/mL (p<0.05). The right heart catheterization demonstrated the distinctive reduction of mean pulmonary artery pressure (mPAP) from 59 ± 6 to 32 ± 4 mm Hg, pulmonary vessel resistance (PVR) from 9,3 ± 2,2 to 3,4 ± 1,5 WU and diastolic pulmonary gradient (DPG) from 11 ± 2.1 to 8 ± 0.8 mm Hg (p<0.05). Also the decrease of pulmonary capillary wedge pressure (PCWP) from 23 ± 3.5 to 19 ± 2.3 mm Hg was also observed (p<0.05). Conclusions: This is the first clinical study to demonstrate the clinical, functional and hemodynamic benefits of cryoablation procedure in patients with combined postcapillary PAH caused by left heart diseases.