title: Carotid body resection for sympathetic modulation in systolic heart failure: results from first-in-man study.
abstract: Augmented reflex responses from peripheral chemoreceptors, which are mainly localized in the carotid bodies (CBs), characterize patients with systolic heart failure and contribute to adrenergic hyperactivation. We investigated whether surgical resection of CBs in these patients can be performed safely to decrease sympathetic tone.
  
  
  
  We studied 10 male patients with systolic heart failure (age, 59 ± 3 years; LVEF, 27 ± 7%) who underwent unilateral right-sided CB resection (four patients) or bilateral CB resection (six 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 the 1-month visit, CB resection was associated with a significant decrease both in 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.
  
  
  
  We present first-in-man evidence that CB resection in patients with systolic heart failure is associated with a decrease in sympathetic activity. A 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.
authors.affiliation: Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Niewinski
authors.affiliation: Department of Vascular Surgery, 4th Military Hospital, Wroclaw, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Janczak
authors.affiliation: Department of Vascular Surgery, 4th Military Hospital, Wroclaw, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Rucinski
authors.affiliation: Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Tubek
authors.affiliation: Cibiem Inc., Los Altos, CA, USA.
authors.forename: Zoar J
authors.initials: ZJ
authors.lastname: Engelman
authors.affiliation: Department of Pulmonology and Lung Cancer, Medical University, Wroclaw, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Piesiak
authors.affiliation: Department of Radiology and Diagnostics Imaging, 4th Military Hospital, Wroclaw, Poland.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Jazwiec
authors.affiliation: Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Banasiak
authors.affiliation: Department of Cardiology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.affiliation: Cibiem Inc., Los Altos, CA, USA.|The Ohio State University, Columbus, OH, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Sobotka
authors.affiliation: Bethesda North Hospital, Cincinnati, OH, USA.|University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Javaheri
authors.affiliation: School of Physiology and Pharmacology, Clinical Research & Imaging Centre, University of Bristol, Bristol, UK.
authors.forename: Emma C J
authors.initials: EC
authors.lastname: Hart
authors.affiliation: School of Physiology and Pharmacology, Clinical Research & Imaging Centre, University of Bristol, Bristol, UK.
authors.forename: Julian F R
authors.initials: JF
authors.lastname: Paton
authors.affiliation: Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.|Department of Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D001784:Blood Gas Analysis; D002344:Carotid Body / Q000601:surgery*; D017079:Exercise Tolerance; D054143:Heart Failure, Systolic / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation; D013564:Sympathetic Nervous System / Q000503:physiopathology*
keywords: Carotid body; Heart failure; Sympathetic modulation