A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta

Joseph J. Ricotta, Catalin Harbuzariu, Juan N. Pulido, Manju Kalra, Gustavo Oderich, Peter Gloviczki, Thomas C. Bower

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: 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.

Original languageEnglish (US)
Pages (from-to)1196-1201
Number of pages6
JournalJournal of Vascular Surgery
Volume55
Issue number4
DOIs
StatePublished - Apr 1 2012

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Thoracic Aorta
Pulmonary Artery
Catheters
Endoleak
Dilatation
Heart Valve Diseases
Arterial Pressure
Hemodynamics
Controlled Hypotension
Hematoma
Hypotension
Myocardial Ischemia
Thorax
Stroke
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta. / Ricotta, Joseph J.; Harbuzariu, Catalin; Pulido, Juan N.; Kalra, Manju; Oderich, Gustavo; Gloviczki, Peter; Bower, Thomas C.

In: Journal of Vascular Surgery, Vol. 55, No. 4, 01.04.2012, p. 1196-1201.

Research output: Contribution to journalArticle

Ricotta, Joseph J. ; Harbuzariu, Catalin ; Pulido, Juan N. ; Kalra, Manju ; Oderich, Gustavo ; Gloviczki, Peter ; Bower, Thomas C. / A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta. In: Journal of Vascular Surgery. 2012 ; Vol. 55, No. 4. pp. 1196-1201.
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abstract = "Objective: 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.",
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