Renal sympathetic denervation in uncontrolled arterial hypertension after successful repair for aortic coarctation

• Published in: International journal of cardiology Vol. 202; pp. 322 - 327
• Main Authors: Lurz, Philipp, Okon, Thomas, Riede, Thomas, Wagner, Robert, Schuler, Gerhard, Daehnert, Ingo, Desch, Steffen
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01.01.2016
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Aortic Coarctation - surgery; Arterial hypertension; Cardiovascular; Coarctation of the aorta; Congenital heart disease; Denervation; Female; Humans; Hypertension - drug therapy; Hypertension - physiopathology; Hypertension - surgery; Kidney - innervation; Male; Prospective Studies; Renal nerves; Renal sympathetic denervation; Treatment Outcome; Renal sympathetic denervation; Arterial hypertension; Congenital heart disease; Renal nerves; Coarctation of the aorta
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2015.09.034

Abstract Background Uncontrolled arterial hypertension is a frequent problem after successful repair of CoA and has been attributed to increased central sympathetic drive as well as a blunted baroreceptor reflex. RSD is a promising therapy to reduce central sympathetic drive and improve baroreflex sensitivity. Methods 8 patients (age: 27 ± 6 years) with previous surgical and/or percutaneous repair of CoA, absence of any relevant restenosis (invasive gradient across the site of previous treatment 3 ± 4 mm Hg) and resistant arterial hypertension (daytime SBP ≥ 140 mm Hg on 24 hour ambulatory blood pressure measurements [ABPM] in spite of the concurrent use of 3 antihypertensive agents of different classes or intolerance to BP medications) were included. Bilateral RSD was performed using the Symplicity Flex™ catheter (Medtronic, MN, USA). Results RSD was successful in all patients with no procedural complications and no evidence for renal artery stenosis 6 months post procedure. From baseline to 6 month follow-up, RSD was followed by a significant reduction in average daytime systolic BP (150.4 ± 7.8 to 143.1 ± 8.0 mm Hg; p = 0.0117) as well as systolic BP throughout 24 h (146.8 ± 7.3 vs. 140.5 ± 7.8, p = 0.04). Conclusion The BP reductions observed in these patients justify engaging in a larger clinical trial on the efficacy of RSD in this specific type of secondary hypertension and bares the hope that RSD might extend the currently very limited armory against arterial hypertension in young adults with previous repair of CoA.