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Published on: August 8, 2025
Rapid pacing technique for preventing ventricular tears during transapical aortic valve replacement
Eric Dumont1, Josep Rodés-Cabau, Robert De LaRochellière
1Department of Cardiovascular Surgery, Laval Hospital, Quebec City, Canada. eric.dumont@crhl.ulaval.ca
Journal of Cardiac Surgery
|May 15, 2009
Summary
A new technique using rapid ventricular pacing during transapical aortic valve replacement (TAVR) minimizes bleeding complications. This method reduces apical tearing and the need for additional sutures, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Transapical aortic valve replacement (TAVR) is an alternative for high-risk aortic stenosis patients.
- Major bleeding complications can occur during sheath removal from the left ventricular apex post-TAVR.
Purpose of the Study:
- To describe a technique for minimizing bleeding complications during TAVR sheath removal.
- To reduce apical tearing and associated bleeding during transapical procedures.
Main Methods:
- Utilized temporary pacing Swan-Ganz catheter and Ethibond 2-0 sutures with pledgets for apical pursestrings.
- Removed the 26F sheath from the ventricular apex under tension-free conditions.
- Employed rapid ventricular pacing exceeding 150 bpm during sheath removal.
Main Results:
- Successfully completed 21 TAVR procedures using the described technique.
- Observed a significant decrease in apical tearing and the need for additional sutures.
- Managed six cases of partial ventricular tearing with rapid pacing, avoiding cardiopulmonary bypass.
Conclusions:
- The described technique effectively reduces ventricular tears and major bleeding during TAVR.
- Rapid ventricular pacing is a valuable adjunct for managing apical access site complications in TAVR.
