Laparoscopic-based perivascular renal sympathetic nerve denervation: a feasibility study in a porcine model

摘要

Background This study aims to evaluate the effects and safety of laparoscopic-based perivascular renal sympathetic nerve denervation (RDN) in a porcine model fed a high-fat diet. Method Thirty-six high-fat diet-fed Bama minipigs were randomly divided into an RDN group (n = 18), in which minipigs received laparoscopic-based perivascular RDN, and a sham group (n = 18). All pigs were fed the high-fat diet after the operation to establish a model of obesity-induced hypertension. Bama pigs in the RDN and sham groups were killed at 3 time points [2 days after RDN (n = 6), day 90 (n = 6) and day 180 (n = 6)]. Result The systolic blood pressure (SBP) and noradrenaline (NE) concentration in the kidney tissue were significantly lower in the RDN group than in the sham group at 2 days (113.83 +/- 3.26 mmHg vs 129.67 +/- 3.32 mmHg,P = 0.011, and 112.02 +/- 17.34 ng/g vs 268.48 +/- 20.61 ng/g,P < 0.001, respectively), 90 days (116.83 +/- 3.88 mmHg vs 145.00 +/- 4.22 mmHg,P = 0.001, respectively) and 180 days (129.33 +/- 2.87 mmHg vs 168.57 +/- 2.86 mmHg,P < 0.001, and 152.15 +/- 16.61 ng/g vs 318.97 +/- 24.84 ng/g,P < 0.001, respectively) after the operation. The diastolic blood pressure (DBP) was significantly lower in the RDN group than in sham group at 90 and 180 days after the operation (72.17 +/- 2.7 mmHg vs 81.50 +/- 2.22 mmHg,P = 0.037, and 76.83 +/- 2.75 mmHg vs 86.33 +/- 2.22 mmHgP = 0.021, respectively). Based on the pathological evaluation, the renal sympathetic nerve fascicles were successfully disrupted by radiofrequency energy after laparoscopic-based perivascular RDN, but the intima was intact. Tyrosine hydroxylase (TH) expression was decreased, while the expression of the S100 protein was increased in treated renal arteries after RDN. Conclusions Laparoscopic-based perivascular RDN prevented the occurrence and development of hypertension, and thus it may be an efficient and safe method for controlling blood pressure in an experimental model.