Alves

Brunner-La Rocca

Chua

Ciarka

Cohn

Conde

De Ferrari

Del Rio

Despas

Floras

Giannoni

Hart

Heusser

Janssen

Krittayaphong

Lorenzi-Filho

Lugliani

Marcus

Moore

Nattie

Nguyen

Niewinski

Niewiński

Notarius

Paton

Pocock

Ponikowski

Pyner

Remo

Sinski

Ukena

Vermeire

Winter

Zoccal

AimsAugmented reflex responses from peripheral chemoreceptors, which are mainly localized in the carotid bodies (CB), characterize patients with systolic heart failure (HF) and contribute to adrenergic hyperactivation. We investigated whether surgical resection of CB in these patients can be performed safely to decrease sympathetic tone.Methods and resultsWe studied 10 male patients with systolic HF (age: 59±3 years, left ventricular ejection fraction: 27±7%) who underwent unilateral right-sided CB resection (4 patients) or bilateral CB resection (6 patients). Primary endpoints of the study were changes in muscle sympathetic nerve activity (MSNA) and peripheral chemosensitivity measured as ventilatory response to hypoxia from baseline to 1 month post-CB resection. Safety analysis included analysis of arterial blood gas and oxygenation at night through 2 months post-procedure and adverse events assessed up to 12-months. At 1-month visit, CB resection was associated with a significant decrease in both MSNA (86.6±3.1 vs. 79.7±4.2 bursts/100 beats, p=0.03) and in peripheral chemosensitivity (1.35±0.19 vs. 0.41±0.17 L/min/SpO2, p=0.005). It also resulted in improved exercise tolerance. Amongst some patients with bilateral CB resection there was a trend towards worsening of oxygen saturation at night, which in one case required therapy with non-invasive ventilation.ConclusionWe present first-in-man evidence that CB resection in patients with systolic HF is associated with decrease in sympathetic activity. Bilateral procedure may carry a risk of worsening oxygenation at night. CB modulation constitutes an interesting research avenue, but careful consideration of the balance between safety and efficacy is necessary before further clinical trials

Niewinski, Piotr

Janczak, Dariusz

Rucinski, Artur

Tubek, Stanislaw

Engelman, Zoar J

Piesiak, Pawel

Jazwiec, Przemyslaw

Banasiak, Waldemar

Fudim, Marat

Sobotka, Paul A

Javaheri, Shahrokh

Hart, Emma C J

Paton, Julian F R

Ponikowski, Piotr

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Carotid body resection for sympathetic modulation in systolic heart failure – results from first-in-man study

Piotr Niewinski

Dariusz Janczak

Artur Rucinski

Stanislaw Tubek

Zoar J. Engelman

Pawel Piesiak

Przemyslaw Jazwiec

Waldemar Banasiak

Marat Fudim

Paul A. Sobotka

Shahrokh Javaheri

Emma C.J. Hart

Julian F.R. Paton

Piotr Ponikowski

Crossref

European Journal of Heart Failure

Carotid body resection for sympathetic modulation in systolic heart failure: results from first-in-man study

https://research-information.bris.ac.uk/files/80894025/Carotid_body_resection_for_sympathetic_modulation_EJHF_accepted.pdf

Carotid body resection for sympathetic modulation in systolic heart failure – results from first-in-man study

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