Pulmonary artery denervation in pulmonary hypertension: mechanism, efficacy, and future directions

Abstract

Pulmonary hypertension is a group of diseases characterized by elevated mean pulmonary arterial pressure. Based on the etiology, there are several classifications, and management is generally focused on reducing pulmonary pressure, addressing the etiology, and preventing the progression of right heart failure. Pulmonary artery denervation (PADN) is a procedure that involves disrupting the sympathetic output to reduce pulmonary artery vasoconstriction and pulmonary artery resistance and improve cardiac function. In this narrative review, we pooled and synthesized data from randomized controlled trials evaluating the key findings, efficacy and safety of PADN. The patient population involved those diagnosed with WHO group 1 (pulmonary arterial hypertension), group 2 (left-sided heart disease), and group 4 (chronic thromboembolic pulmonary hypertension), of varying sample sizes and demographics. We discuss the mechanistic insights into PADN’s efficacy, compared with existing therapies for pulmonary hypertension, and compare the different techniques in PADN, such as catheter-based denervation, ultrasound-guided denervation, chemical and surgical, highlighting the benefits and limitations of various procedures. Meta-analyses conducted between 2022 and 2025 were also discussed, and a general trend of improvement in 6-min walking distance (6MWD), reduction in mean pulmonary artery pressure and pulmonary vascular resistance was observed. Although most studies observed no improvement in mortality and readmission rates, larger clinical studies are needed to establish the role of PADN in routine clinical practice. Studies and technological advances must also be conducted to refine the procedures for optimized patient outcomes.