Intentional asystole during endoluminal thoracic aortic surgery without cardiopulmonary bypass

Abstract

We describe in three patients the use of adenosine to arrest the heart without cardiopulmonary bypass during endoluminal repair of thoracic aortic aneurysms. The pharmacology of adenosine, a purine nucleoside present in all cells, is reviewed briefly, with special reference to its use in causing transient asystole, which is required for successful surgical expansion of the graft stent in the thoracic aorta.

Simultaneous treatment of thoracic and infrarenal aortic aneurysm using a combination of conventional surgery and endoluminal stent grafting

“…To improve exact deployment of the stent proximally and prevent dislocation during balloon inflation, Mitchell recommends lowering of the mean systemic arterial blood pressure by the anesthesiologist to a maximum of about 50 mmHg by administration of vasodilators or beta-blockers [4]. Different groups have advocated induction of ventricular fibrillation or an intentional asystole by adenosine during the phase of stent deployment [14,15]. In our patient, we did not see the necessity for major cardiac manipulation.…”

Partial right atrial inflow occlusion for controlled systemic hypotension during thoracic endovascular aortic repair

“…2,3 Although effective in most instances, some patients only reach bradycardia instead of asystole, the onset of action and dose-response are variable, and duration of asystole is fairly short at a mean of 5 seconds, which may not allow sufficient time to perform the intervention.…”

Anaesthesia for stent graft repair of thoracic aneurysm and coarctation of the aorta

“…Cerebral haemorrhage secondary to sudden hypertension would also be exacerbated by the heparin required for the procedure. An alternative method for reducing the risk of displacement has been to produce a period of asystole with adenosine [5], or a period of induced ventricular fibrillation [6].…”