First Experience with the Munich Valsalva Implantation Technique (MuVIT) for Cardiac Output Reduction During Standard and Complex Thoracic Endovascular Aortic Repair.
Aortic Dissection
/ surgery
Aorta, Thoracic
/ diagnostic imaging
Aortic Aneurysm, Thoracic
/ diagnostic imaging
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
/ methods
Cardiac Output
Cohort Studies
Endovascular Procedures
/ methods
Humans
Prosthesis Design
Pulmonary Disease, Chronic Obstructive
/ etiology
Retrospective Studies
Time Factors
Treatment Outcome
Aortic arch
Blood pressure reduction
Cardiac output reduction
PEEP
Physiology
TEVAR
Valsalva
Vena cava occlusion
Journal
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
ISSN: 1532-2165
Titre abrégé: Eur J Vasc Endovasc Surg
Pays: England
ID NLM: 9512728
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
05
09
2021
revised:
01
01
2022
accepted:
06
02
2022
pubmed:
30
4
2022
medline:
20
7
2022
entrez:
29
4
2022
Statut:
ppublish
Résumé
The Munich Valsalva Implantation Technique (MuVIT) is a non-invasive alternative which uses a modified Valsalva manoeuvre to reduce cardiac output (CO). The aim of this study was to evaluate the technical success and safety of MuVIT in standard and complex endovascular thoracic aneurysm repair (TEVAR). This was a retrospective single centre cohort study. Patients were included who underwent CO reduction with MuVIT between March 2020 and February 2021 for standard and fenestrated/branched TEVAR (fbTEVAR). The target systolic blood pressure (SBP) reduction was used as an indicator of CO reduction. The aim of the SBP reduction was 50% in patients undergoing proximal sealing in Ishimaru zones 0-1 (Group 1), and 30% in patients with sealing in Ishimaru zones 2-3 (Group 2). Efficacy outcomes included MuVIT technical success and procedural technical success. Safety outcomes included MuVIT and procedural related complications in the first 30 days. During the study period 52 cases were screened for MuVIT. Of these, 40 patients (77%) underwent procedures that were performed under MuVIT. Exclusion reasons were local anaesthesia (n = 9); pulmonary contraindications (n = 2), and poor heart pump function (n = 1). Fifteen patients (37.5%) underwent bTEVAR, three patients (7.5%) fTEVAR, and 22 patients (55%) standard TEVAR. Twenty nine (72.5%) procedures were elective, seven (17.5%) were urgent, and four (10%) were as an emergency. Successful proximal endograft deployment under MuVIT was 100%. The target SBP reduction was achieved in 95% (Group 1: 89.5%, Group 2: 100%), with an overall mean reduction of 46% (Group 1: 55%, Group 2: 40%). The 30 day mortality was 7.5%, and was not MuVIT related. Two patients with COPD Gold III/IV developed respiratory complications. MuVIT is a safe and effective manoeuvre for CO reduction during aortic arch TEVAR. However, careful patient selection is required and potential adverse effects on patients with severe COPD needs further evaluation.
Identifiants
pubmed: 35487842
pii: S1078-5884(22)00080-6
doi: 10.1016/j.ejvs.2022.02.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
817-826Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022. Published by Elsevier B.V.