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Inferior Vena Cava-Balloon Occlusion and Its Effect on the Myocardium During Endograft Deployment in the Arch
Angelos Karelis1, Nuno V Dias1, Anders Holmström2
1Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
Insights
Inferior vena cava (IVC) balloon occlusion is a feasible technique for reducing cardiac output during thoracic aortic endovascular repair. While generally safe, about a quarter of patients showed elevated troponin levels, warranting further investigation.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Interventional Cardiology
Background:
- Endovascular repair of thoracic aortic pathologies requires careful hemodynamic management.
- Intraoperative cardiac output reduction techniques are crucial for patient safety.
Purpose of the Study:
- To evaluate the impact of inferior vena cava (IVC) balloon occlusion on myocardial function.
- To assess the feasibility of IVC balloon occlusion for cardiac output reduction during thoracic aortic endovascular repair.
Main Methods:
- Prospective observational cohort study of 21 patients undergoing endovascular thoracic aortic repair.
- Inclusion of IVC balloon occlusion for intraoperative cardiac output reduction.
- Monitoring of hemodynamic parameters, cardiac troponin T levels, and left ventricular ejection fraction.
Main Results:
- IVC balloon occlusion was technically successful in all patients.
- Median time to achieve hypotension was 60 seconds, with blood pressure recovery in 135 seconds.
- Twenty-four percent of patients exhibited a >50% change in Troponin T levels; 10% developed new atrial fibrillation, and 5% had peri-operative myocardial infarction.
Conclusions:
- IVC balloon occlusion is a feasible method for cardiac output reduction in thoracic aortic endovascular repair.
- Significant troponin leakage observed in a subset of patients requires further study to determine clinical significance.
Purpose:
To evaluate the impact of cava balloon occlusion on the myocardium during endovascular repair of thoracic aortic pathologies.
Material And Methods:
A prospective observational cohort study of 21 patients who underwent endovascular repair of aortic arch and thoracic aorta in a single tertiary referral center with use of inferior vena cava (IVC) balloon occlusion as a method of intraoperative cardiac output reduction. Pre-, intra-, and postoperative measurements of heart rate, blood pressure, stroke volume index, and central venous oxygen saturation were noted. High-sensitive serum troponin levels were also analyzed according to a pre-established protocol. Endpoints were cardiac troponin T levels after induced hypotension and left ventricular ejection fraction during follow-up. Secondary endpoints were procedure technical success and overall survival.
Results:
Twenty-one patients (18 male, median age 69, (62-75, IQR)) enrolled in the study between May 2015 and January 2019. Indication for endovascular treatment was an aortic arch aneurysm (n=10), descending aortic aneurysm (n=8), lusorian artery aneurysm (n=2), and thoracoabdominal aortic aneurysm (n=1). Median time to reach half mean arterial pressure was 60 seconds while median recovery time of blood pressure was 135 seconds. In 5 (24%) cases, we observed a > 50% change of Troponin T on the reference level. Technical success was achieved in all cases. Two (10%) patients developed new and persistent atrial fibrillation and 1 (5%) suffered a peri-operative ST-elevation myocardial infarction.
Conclusion:
The use of IVC balloon occlusion is a feasible technique for cardiac output reduction during endovascular repair of thoracic aortic pathologies. One fourth of the patients develop significant troponin leakage but the significance of the finding needs further studies.
