The use of right ventricular pacing to facilitate stent graft deployment in the distal aortic arch: A case report (original) (raw)
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Rapid Ventricular Pacing to Lower Blood Pressure During Endograft Deployment in the Thoracic Aorta
The Annals of Thoracic Surgery, 2006
Controlled hypotension is critical to the accurate deployment of aortic endografts and safe balloon post-dilation. We describe the use of rapid ventricular pacing during 15 aortic stenting procedures. An immediate and sustained reduction in both phasic and mean blood pressure was achieved in all patients. This procedure has advantages over pharmacologic or other methods of blood pressure reduction.
Journal of Vascular Surgery, 2012
Controlled hypotension is critical for precise deployment of endografts in the thoracic aorta and for safe balloon dilation after deployment. We describe a novel approach to rapid right ventricular pacing using a pulmonary artery catheter (PAC) that is placed during the procedure for hemodynamic monitoring. Methods: The study included 27 patients (20 men and seven women), with a mean age of 74 years, who underwent endograft placement in the thoracic aorta with PAC-directed rapid right ventricular pacing. Hemodynamic parameters, accuracy of deployment, complications related to rapid right ventricular pacing and PAC placement, presence of endoleaks, and postoperative complications were evaluated. Results: PAC-directed rapid right ventricular pacing was performed during endograft deployment and balloon dilation after deployment without technical difficulty. Each patient underwent a median of two pacing episodes (range, 1-4). The length of each pacing episode was a mean of 11 seconds (range, 8-14 seconds). Mean pacing rate was 170 ؎ 15 beats/min, which achieved an average mean arterial pressure (MAP) of 42 ؎ 8 mm Hg. After pacing cessation, the recovery time of MAP to prepacing levels was <5 seconds (mean, 2 seconds) in all but one patient. All endografts were precisely deployed at a mean of 2 mm from the intended placement site, and there was no unintentional branch vessel coverage. One patient with severe valvular heart disease died. There were nine endoleaks, one postoperative stroke (4%), and one access wound hematoma (4%). Conclusions: PAC-directed rapid right ventricular pacing is an effective method of inducing hypotension, enabling precise thoracic endograft deployment and safe balloon dilation after deployment. However, despite these advantages, the technique may be contraindicated in patients with severe valvular or ischemic heart disease.
Tolerance of Rapid Right Ventricular Pacing during Thoracic Endovascular Aortic Repair
Annals of vascular surgery, 2015
The objective of this retrospective study was to evaluate the tolerance of rapid right ventricular pacing (RRVP) compared with that of the traditional methods of hypotension used during thoracic endovascular aortic repair (TEVAR). From January 2002 to December 2012, we retrospectively included all the patients treated with TEVAR by comparing the 2 groups: patients operated with RRVP (RRVP+) and those operated without RRVP (RRVP-). The characteristics of the population and the procedures were recorded. The rates of complications were compared up to 1 year. Sixty-one patients were operated. Treated pathologies were multiple with 19 aneurysms, 14 false aneurysms, 12 isthmic ruptures, 11 dissections, 3 coarctations, and 2 endoleaks. Twenty-four patients were RRVP+ and 37 patients were RRVP-. Mortality rates at 1 month in groups RRVP+ and RRVP- were of 0% and 2.7%, respectively (P = 1), and reintervention rates were 0% and 13.5%, respectively (P = 0.15). Three peroperative rhythm disorde...
The Annals of Thoracic Surgery, 2009
Background. In complex thoracic aortic procedures, proximal repair and antegrade stent grafting of the descending aorta is an emerging technique to achieve one-stage treatment of the thoracic aorta. To overcome problems of proximal endoleak, a hybrid stent graft was designed and used. This study assessed technical feasibility and early results. Methods. From Jan 2005 to May 2008, 41 patients (age, 60 ؎ 13 years) comprising 35 aortic dissections (AD) and 6 aortic aneurysms underwent arch replacement and antegrade stent grafting of the descending aorta using the hybrid stent graft. Endoleaks were evaluated by computed tomography (CT) scans. In AD cases, the false lumen (FL) was evaluated with CT volume measurements. Results. Combined arch replacement and antegrade stent grafting was technically successful. One proximal endoleak was observed, which was not related to the hybrid prosthe-sis (40 of 41, 98%). Three patients died (7%). No paraplegia occurred. Incidence of immediate FL thrombosis was 97% at the proximal and 80% at the distal stent graft level. During follow-up (17 ؎ 11 months), complete thrombosis of the perigraft space was 91%. FL volume shrinkage was documented (p < 0.01). No perfusion of the perigraft space was observed in aneurysm cases. Intermediate survival was 33 of 38 (87%). Conclusions. One-stage repair of complex thoracic aortic disease using a hybrid stent graft can be reliably performed with low hospital mortality. Proximal endoleak can be definitely avoided; in AD, exclusion and ongoing significant shrinkage of the FL can be achieved.
Canadian Journal of Cardiology, 2015
Background Endovascular options to repair the arch and ascending aorta are rapidly evolving. Little is known about the durability of endovascular devices deployed at this location. This report describes a single centre experience with this novel application of Thoracic Endovascular Aortic Repair (TEVAR) by examining clinical and radiologic outcomes. Methods Retrospective review was performed for a cohort of patients undergoing TEVAR of the arch and/or ascending aorta at a single centre from November 2008 to July 2012. Results Sixteen patients were included in the study with mean imaging follow-up of 38 months (range: 15 to 72 months). Two complications at the proximal landing zone in the ascending aorta were identified: 1 endoleak and 1 infolding identified at 3 and 24 months postoperatively. Clinically, both of these complications were attributed to bird-beaking at the proximal landing zone site. At up to 72 months of follow-up, there were no cases of retrograde dissection of the native sinus of valsalva. There were no cases of stent graft migration, graft fracture, open surgical reintervention for aortic pathology or late mortality. Conclusions Early outcomes suggest the current generation of thoracic aortic endografts can be placed in the complex anatomy of the ascending aorta and aortic arch without a high incidence of early graft fracture or migration. Future endeavours will need to focus on techniques to achieve optimal apposition with the curves of the ascending aorta. These findings are important as indications for endovascular aortic therapies expand to address proximal aortic pathology.