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Transvenous permanent pacemaker implantation after debranching thoracic endovascular aortic repair; A case series
Manabu Kashiwagi1, Akio Kuroi1, Natsuki Higashimoto1
1Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Insights
Debranching thoracic endovascular aortic repair can impact cardiac device implantation. Strategies must adapt to bypass graft configuration for successful pacemaker placement.
Area of Science:
- Cardiovascular Surgery
- Medical Device Implantation
- Thoracic Endovascular Aortic Repair
Background:
- Debranching thoracic endovascular aortic repair (TEVAR) involves complex bypass grafting.
- These grafts may anatomically interfere with cardiac implantable electronic device (CIED) placement.
- Optimizing CIED implantation in TEVAR patients requires careful consideration of surgical strategy.
Observation:
- Case 1: A multi-artery debranching graft obstructed left-sided CIED implantation, necessitating a right-sided approach.
- Case 2: A visible axillary artery bypass graft allowed for conventional left-sided CIED implantation via extra-thoracic puncture.
- Successful CIED implantation was achieved in both cases, demonstrating adaptable strategies.
Findings:
- The number of debranched arteries directly influences the feasibility of standard anterior thoracic CIED implantation.
- Fluoroscopic visibility of the bypass graft is a critical factor in determining the optimal implantation site and technique.
- Successful CIED implantation strategies are contingent upon the specific anatomical alterations caused by TEVAR debranching procedures.
Implications:
- These findings highlight the need for pre-procedural planning to anticipate and manage potential conflicts between TEVAR and CIED implantation.
- Modified CIED implantation techniques may be required based on the extent of aortic arch debranching.
- Further research should explore standardized guidelines for CIED placement in patients undergoing TEVAR with debranching procedures.
Abstract:
Debranching thoracic endovascular aortic repair may disturb the implantation of a cardiac implantable electronic device in the anterior thoracic region. In case 1, the bypass graft between the right axillary artery, left axillary artery, and left common carotid artery disturbed pacemaker implantation from the left anterior thoracic region. Therefore, right-sided implantation was selected. By contrast, in case 2, the bypass graft between axillary arteries in the anterior thoracic region was visible on fluoroscopy, and we performed conventional left-sided pacemaker implantation with extra-thoracic puncture. The pacemaker implantations were successful in both cases. The implantation strategies were affected by the number of debranched arteries and visibility of the bypass graft.
