Interventional strategies for pulmonary arterial hypertension: Current perspectives and future directions

Abstract Pulmonary arterial hypertension (PAH) often leads to right heart failure and death. While pharmacological therapies offer symptomatic relief and functional improvement, many patients remain refractory or progress despite optimal treatment. This review explores emerging interventional strategies besides pharmacotherapy. Techniques such as pulmonary artery denervation (PADN), balloon atrial septostomy (BAS), renal denervation, transcatheter Potts shunt, right ventricular assist devices, catheter-based cell therapies and implantable hemodynamic monitoring devices are evaluated based on safety, efficacy, and long-term outcomes. Notably, PADN has demonstrated encouraging results across multiple trials, with improvements in exercise capacity, hemodynamic parameters, and clinical status. BAS remains a palliative bridge to transplantation in severe cases, with newer modifications aiming to overcome spontaneous closure. Renal denervation and transcatheter Potts shunts show promise but require further validation. Catheter-based cell therapies show promising results and could perhaps be used as an alternative in the future. Moreover, mechanical support devices like ECMO and pressure monitors such as CardioMEMS offer adjunctive benefits in advanced disease. Right ventricular assist devices could in circumstances be used as bridge to transplant or bridge to recovery. This review illustrates the need for robust randomized controlled trials in PAH.