Transcatheter Pulmonary Denervation in Patients with Left Heart Failure with Reduced Ejection Fraction and Combined Precapillary and Postcapillary Pulmonary Hypertension: A Prospective Single Center Experience.

Objectives The present study was a prospective, single-center, single-arm study to investigate the efficacy of transcatheter pulmonary artery denervation (TPADN) in patients with combined postcapillary and precapillary PH (Cpc-PH) associated with left heart failure with reduced ejection fraction (HF-rEF). Background Pulmonary hypertension (PH) in patients with left ventricular systolic dysfunction has a negative impact on outcome. Methods The combination of pulmonary artery systolic pressure (PAPs) >= 60 mmHg, transpulmonary pressure gradient (TPG) >= 12 mmHg, nonreversible mean PAP, and pulmonary vascular resistance (PVR) >= 3.5 Wood Units was considered as too high risk for heart transplantation (HTx). The clinical efficacy endpoint was an improvement in 6-min walking test and the hemodynamic endpoints were changes in PAPs, PVR, and TPG between baseline and 6 months. Circumferential radiofrequency applications were delivered around distal main, left and right pulmonary arteries. At each ablation point temperature was 45 degrees C and energy 10 W. Results TPADN was performed in 10 patients. At 6-month in 5 patients we observed reduction in PAP, PVR, TPG, and DPG and then 1 had successful HTx, 2 are on HTx waiting list, 2 received LVADs, 2 patients did not improve, and 3 patients died. Conclusions TPADN may be beneficial in selected patients with HF-rEF and Cpc-PH.