Rapid artificial ventricular pacing for thoracic endovascular aortic repair

Abstract

Aim: Rapid artificial ventricular pacing (RAVP) is a reproducible method for rapid and reversible reduction of transvascular flow during endovascular procedures. This method has the potential to increase patient tolerance, reduce operation duration, infection risk, X-ray dose and facilitate early patient mobilisation. The aim of this study to compare the efficacy, safety and impact of RAVP and pharmacological-induced hypotension in patients who underwent thoracic endovascular aortic repair (TEVAR) procedures for aortic dissection and aneurysm. Material and Methods: This retrospective, observational, case-control study was conducted between January 2014 and December 2022. The adult patients who underwent TEVAR procedures for aortic dissection and aneurysm were enrolled in this study. Mean arterial pressure, heart rate, total operation duration, incidence of endoleak, duration of intensive care unit-hospitalization stay, and hospital mortality ratio were compared between nitroglycerin induced hypotension group and RAVP group. Results: A total of 279 patients who underwent TEVAR procedures were included in this study. The mean age of patients in this cohort was 65.6±5.7 years and 158 (56.6%) of the patients were male. Of these 279 patients, hypotension during stent-graft was achieved with nitroglycerin in 155 patients. There were no statistical differences between these two groups in terms of age, gender, body mass index, comorbidities and drugs. The blood pressure lowering effect and the heart rate during the intervention was significantly higher in RAVP. Endoleak and hospital mortality rates were similar in each group. Conclusion: RAVP is a feasible and safe method because it paves the way for agile maneuvers to maintain optimal hemodynamic conditions. Besides this, more meticulous, accurate deployment of endograft can be established with RAVP.