What Is the Best Method to Achieve Safe and Precise Stent-Graft Deployment in Patients Undergoing TEVAR?

Roman Gottardi; Tim Berger; Andreas Voetsch; Andreas Winkler; Philipp Krombholz-Reindl; Andre Farkouh; Stoyan Kondov; Bartosz Rylski; Ralf Sodian; Martin Czerny

doi:10.1055/s-0040-1710581

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2021; 69(04): 357-361
DOI: 10.1055/s-0040-1710581

Review Article

What Is the Best Method to Achieve Safe and Precise Stent-Graft Deployment in Patients Undergoing TEVAR?

Roman Gottardi

¹Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany

²Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria

,

Tim Berger

³Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany

⁴Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany

,

Andreas Voetsch

²Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria

,

Andreas Winkler

²Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria

,

Philipp Krombholz-Reindl

²Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria

,

Andre Farkouh

⁵Division of Clinical Pharmacy and Diagnostics, Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria

,

Stoyan Kondov

³Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany

⁴Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany

,

Bartosz Rylski

³Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany

⁴Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany

,

Ralf Sodian

¹Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany

,

Martin Czerny

³Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany

⁴Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany

› Author Affiliations

Abstract

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Abstract

Thoracic endovascular aortic repair (TEVAR) for aortic pathologies requires sufficient landing zone of ideally more than 25 mm for safe anchoring of the stent-graft and prevention of endoleaks. In the aortic arch and at the thoracoabdominal transition, landing zone length is usually limited by the offspring of the major aortic side-branches. Exact deployment of the stent-graft to effectively use the whole length of the landing zone and to prevent occlusion of one of the side-branches is key to successful TEVAR. There are numerous techniques described to lower blood pressure and to reduce or eliminate aortic impulse to facilitate exact deployment of stent-grafts including pharmacologic blood pressure lowering, adenosine-induced asystole, inflow occlusion, and rapid pacing. Aim of this review was to assess the current literature to identify which of the techniques is best suited to prevent displacement and allow for precise placement of the stent-graft and safe balloon-molding.

Keywords

review - TEVAR - stent-graft - rapid pacing - induced hypotension - inflow occlusion - adenosine

Full Text

References

References
1 Grabenwöger M, Alfonso F, Bachet J. et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2012; 33 (13) 1558-1563
2 Czerny M, Schmidli J, Adler S. et al; EACTS/ESVS scientific document group. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55 (01) 133-162
3 Ito E, Kanaoka Y, Maeda K, Ohta H, Ishida A, Ohki T. Deployment Accuracy of the Conformable GORE(®) TAG(®) Thoracic Endoprosthesis in the Treatment of Zones 2 and 3 Aortic Arch Aneurysms Compared with the Previous TAG(®). Ann Vasc Dis 2015; 8 (02) 74-78
4 Gottardi R, Mudge T, Czerny M. et al. A truly non-occlusive stent-graft moulding balloon for thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2019; 29 (03) 352-354
5 Kleiman NS, Maini BJ, Reardon MJ. et al; CoreValve Investigators. Neurological events following transcatheter aortic valve replacement and their predictors: a report from the CoreValve trials. Circ Cardiovasc Interv 2016; 9 (09) e003551 . Doi: 10.1161/CIRCINTERVENTIONS.115.003551
6 Lhommet P, Espitalier F, Merlini T, Marchand E, Aupart M, Martinez R. Tolerance of rapid right ventricular pacing during thoracic endovascular aortic repair. Ann Vasc Surg 2015; 29 (03) 578-585
7 Nienaber CA, Kische S, Rehders TC. et al. Rapid pacing for better placing: comparison of techniques for precise deployment of endografts in the thoracic aorta. J Endovasc Ther 2007; 14 (04) 506-512
8 Ishiguchi T, Nishikimi N, Usui A, Ishigaki T. Endovascular stent-graft deployment: temporary vena caval occlusion with balloons to control aortic blood flow-experimental canine study and initial clinical experience. Radiology 2000; 215 (02) 594-599
9 Chen J, Huang W, Luo S, Yang D, Xu Z, Luo J. Application of rapid artificial cardiac pacing in thoracic endovascular aortic repair in aged patients. Clin Interv Aging 2014; 9: 73-78
10 Bernard EO, Schmid ER, Lachat ML, Germann RC. Nitroglycerin to control blood pressure during endovascular stent-grafting of descending thoracic aortic aneurysms. J Vasc Surg 2000; 31 (04) 790-793
11 von Knobelsdorff G, Höppner RM, Tonner PH. et al. Induced arterial hypotension for interventional thoracic aortic stent-graft placement: impact on intracranial haemodynamics and cognitive function. Eur J Anaesthesiol 2003; 20 (02) 134-140
12 Lee WA, Martin TD, Gravenstein N. Partial right atrial inflow occlusion for controlled systemic hypotension during thoracic endovascular aortic repair. J Vasc Surg 2008; 48 (02) 494-498
13 Marty B, Morales CC, Tozzi P, Ruchat P, Chassot P-G, von Segesser LK. Partial inflow occlusion facilitates accurate deployment of thoracic aortic endografts. J Endovasc Ther 2004; 11 (02) 175-179
14 Fang TD, Lippmann M, Kakazu C. et al. High-dose adenosine-induced asystole assisting accurate deployment of thoracic stent grafts in conscious patients. Ann Vasc Surg 2008; 22 (05) 602-607
15 Dorros G, Cohn JM. Adenosine-induced transient cardiac asystole enhances precise deployment of stent-grafts in the thoracic or abdominal aorta. J Endovasc Surg 1996; 3 (03) 270-272
16 Plaschke K, Böckler D, Schumacher H, Martin E, Bardenheuer HJ. Adenosine-induced cardiac arrest and EEG changes in patients with thoracic aorta endovascular repair. Br J Anaesth 2006; 96 (03) 310-316
17 Rangel-Castilla L, Russin JJ, Britz GW, Spetzler RF. Update on transient cardiac standstill in cerebrovascular surgery. Neurosurg Rev 2015; 38 (04) 595-602
18 Pelter MM, Carey MG, Kasmani R, Irani F. Adenosine during arrhythmia. Am J Crit Care 2010; 19 (02) 189-190
19 Ricotta II JJ, Harbuzariu C, Pulido JN. et al; J.J. RII. A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta. J Vasc Surg 2012; 55 (04) 1196-1201
20 Bokoch MP, Hiramoto JS, Lobo EP, Shalabi A. Rapid ventricular pacing for landing zone precision during thoracic endovascular aortic arch repair: a case series. J Cardiothorac Vasc Anesth 2017; 31 (06) 2141-2146
21 Pornratanarangsi S, Webster MWI, Alison P, Nand P. Rapid ventricular pacing to lower blood pressure during endograft deployment in the thoracic aorta. Ann Thorac Surg 2006; 81 (05) e21-e23
22 Karaaslan P, Darin K, Zyksel A. et al. Effect of rapid ventricular pacing on cerebral oxygenation in transcatheter aortic valve implantation (TAVI): role of routine near-infrared spectroscopy monitoring. Biomed Res 2017; 28 (07) 3176-3181
23 Selle A, Figulla HR, Ferrari M. et al. Impact of rapid ventricular pacing during TAVI on microvascular tissue perfusion. Clin Res Cardiol 2014; 103 (11) 902-911
24 Bagur R, Webb JG, Nietlispach F. et al. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 2010; 31 (07) 865-874
25 Fefer P, Bogdan A, Grossman Y. et al. Impact of rapid ventricular pacing on outcome after transcatheter aortic valve replacement. J Am Heart Assoc 2018; 7 (14) e009038 . Doi: 10.1161/JAHA.118.009038
26 Rengier F, Weber TF, Henninger V. et al. Heartbeat-related distension and displacement of the thoracic aorta in healthy volunteers. Eur J Radiol 2012; 81 (01) 158-164