title: A novel approach using pulmonary artery catheter-directed rapid right ventricular pacing to facilitate precise deployment of endografts in the thoracic aorta.
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.
authors: Emory University School of Medicine, 1365 Clifton Rd, NE, Building A, Ste 3200, Atlanta, GA 30322, USA. jjricot@emory.edu
authors: Joseph J
authors: JJ
authors: Ricotta
authors: Catalin
authors: C
authors: Harbuzariu
authors: Juan N
authors: JN
authors: Pulido
authors: Manju
authors: M
authors: Kalra
authors: Gustavo
authors: G
authors: Oderich
authors: Peter
authors: P
authors: Gloviczki
authors: Thomas C
authors: TC
authors: Bower
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002404:Catheterization / Q000379:methods; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D016896:Treatment Outcome