Pulm Circ. 2026 Oct 6;16(4):e70404. doi: 10.1002/pul2.70404. eCollection 2026 Oct.
ABSTRACT
Pulmonary hypertension (PH) is common in patients undergoing transcatheter mitral edge-to-edge repair (M-TEER) and is an established determinant of adverse outcomes after intervention. Importantly, persistent PH after technically successful M-TEER remains associated with ongoing symptoms, right ventricular dysfunction and poor prognosis, yet no dedicated treatment strategy has been established. The aim of this study is to evaluate the safety and efficacy of pulmonary artery denervation (PADN) in patients with persistent PH following successful M-TEER. Six patients (median age 69.0 years; 1 female) with WHO Group 2 PH and persistent symptoms despite successful M-TEER underwent PADN at a median of 583 days after valve repair. All patients had trace to mild residual MR (grade 1+) with median mean mitral valve gradient 3.0 mmHg. Right heart catheterization (RHC) was performed at baseline, immediately post-PADN, and at 6-month follow-up. Immediately post-PADN, mean pulmonary artery pressure (mPAP) decreased from 38.5 (3.8) mmHg to 34.0 (11.5) mmHg (p = 0.028). Pulmonary arterial wedge pressure decreased from 22.5 (7.5) mmHg to 20.0 (6.2) mmHg (p = 0.026). At 6-month follow-up, a directional but statistically non-significant trend toward maintained mPAP reduction was observed [median 32.5 (9.0) mmHg vs. baseline 38.5 (3.8) mmHg; p = 0.075]. Tricuspid regurgitation grade improved in 5 of 6 patients (83%). Median 6-min walk distance increased from 377 (109) m to 436 (109) m (p = 0.046). No procedural complications occurred. PADN appears feasible, safe, and potentially effective in patients with persistent PH following M-TEER, warranting further investigation in controlled studies.
PMID:42840917 | PMC:PMC13640058 | DOI:10.1002/pul2.70404