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

Lee, W. Anthony; Martin, Tomas D.; Gravenstein, Nikolaus

doi:10.1016/j.jvs.2008.03.003

Cited by 35 publications

(21 citation statements)

References 10 publications

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“…In cases where the endograft was placed in Zone 0, controlled hypotension was achieved with inflation and downward traction of an occlusion balloon at the right atrial-caval confluence via femoral vein access. 9 If this maneuver was not successful in adequately reducing the blood pressure, momentary cardiac arrest was achieved with intravenous injection of adenosine. In order to perform zone 0 cases correctly, three people were needed; one at the head of the patient and two at the foot of the bed.…”

Section: Methodsmentioning

confidence: 99%

Endovascular debranching of the aortic arch during thoracic endograft repair

Cires

Noll

Albuquerque

et al. 2011

Journal of Vascular Surgery

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Section: Methodsmentioning

confidence: 99%

Endovascular debranching of the aortic arch during thoracic endograft repair

Cires

Noll

Albuquerque

et al. 2011

Journal of Vascular Surgery

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“…In addition to puncture-related complications, RACP can cause tachycardia and bradycardia as well. In patients without established heart diseases or previous tachycardia, the likelihood of acquired tachycardia is less than 1% 14. In patients with left bundle branch block, occurrences of pacemaker dependency should be expected; a permanent pacemaker is needed in some cases.…”

Section: Discussionmentioning

confidence: 99%

Application of rapid artificial cardiac pacing in thoracic endovascular aortic repair in aged patients

Chen¹,

Huang²,

Luo³

et al. 2013

CIA

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ObjectiveTo compare the safety, efficacy, and impact on stent graft positioning between rapid artificial cardiac pacing (RACP), induced hypotension and sodium nitroprusside (SNP) induced hypotension during thoracic endovascular aortic repair (TEVAR) for Stanford B aortic dissection.MethodsOne hundred and sixty-eight patients, who were diagnosed with Stanford B aortic dissection and who underwent selective TEVAR in Guangdong General Hospital and the People’s Hospital of Baoan District, Shenzhen, People’s Republic of China, were enrolled in this study. Patients were randomly divided into a RACP group (n=77) and a SNP group (n=91). During localization and deployment of the stent graft, hypotension was induced by RACP or intravenous SNP, according to randomization. Hemodynamics, landing precision (deviation from planned placement site), duration of procedure, renal function, neurocognitive function, and incidence of endoleaks and paraplegia/hemiplegia were compared. Except for methods of inducing hypotension, TEVAR was performed according to the same protocol in each group.ResultsRACP was successfully performed in all patients assigned to the RACP group. Compared with the SNP group, blood pressure was significantly lower (43±5 versus 81±6 mmHg, P=0.003) and the restoration time of blood pressure and the operation duration were significantly shorter (7±2 versus 451±87 seconds, P<0.001; 87±15 versus 106±18 minutes, P<0.001, respectively) in the RACP group. Stent graft localization/deployment was more precise in the RACP group (2±1 versus 5±2 mm, P<0.001). Compared to baseline, there was no significant change after TEVAR in either group in regard to renal function, neurocognitive function, and incidence of endoleaks and paraplegia/hemiplegia.ConclusionRACP can be safely applied to patients undergoing TEVAR for Stanford B dissection. RACP can shorten the operation duration and facilitate precise graft localization/deployment.

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“…Lee et al [8][9][10] have advocated partial right atrial inflow occlusion for thoracic endovascular aneurysm repair to induce controlled hypotension. In our patients, due to passage of the endograft through the aortic valve, we caused abrupt regur- gitation across the aortic valve.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of ascending aortic pathology

Kolvenbach

Karmeli

Pinter

et al. 2011

Journal of Vascular Surgery

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Stent grafting of the ascending aorta is technically feasible but should be reserved for selected high-risk patients only, preferably in centers where vascular specialists cooperate closely with interventional cardiologists. Cardiac surgery with cardiopulmonary bypass is still the gold standard to treat ascending aortic aneurysms. Stent graft exclusion of more advanced and complex ascending aortic pathology should be performed only in centers with the necessary experience in transvalvular cardiac procedures.

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

Cited by 35 publications

References 10 publications

Endovascular debranching of the aortic arch during thoracic endograft repair

Endovascular debranching of the aortic arch during thoracic endograft repair

Application of rapid artificial cardiac pacing in thoracic endovascular aortic repair in aged patients

Endovascular management of ascending aortic pathology

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