Autor:innen:
Dr. med. Jan Stana | University Hospital, LMU Munich, Munich, Germany | Germany
Dr. med. Carlota Fernandez Prendes | University Hospital, LMU Munich, Munich, Germany | Germany
Aldin Mehmedovic | University Hospital, LMU Munich, Munich, Germany | Germany
Prof. Dr. med. Barbara Rantner | University Hospital, LMU Munich, Munich, Germany | Germany
Priv-Doz. Dr. med Konstantinos Stavroulakis | University Hospital, LMU Munich, Munich, Germany | Germany
Benedict Ginthoer | University Hospital, LMU Munich, Munich, Germany | Germany
PD Dr. Jan-Michael Abicht | University Hospital, LMU Munich, Munich, Germany | Germany
Uni. Prof. Dr. med. Nikolaos Tsilimparis | University Hospital, LMU Munich, Munich, Germany | Germany
Objective: Precise deployment of endografts in the aortic arch and proximal thoracic aorta requires reduction of the cardiac output (CO). Current techniques, such as ventricular rapid pacing, vena cava balloon occlusion or adenosine–induced cardiac asystole, are invasive and are not exempt from complications. The MuVIT (Munich-Valsalva Implantation-Technique) is a non-invasive alternative, which uses a modified Valsalva maneuver to compress the large thoracic veins, subsequently reducing the CO. The aim of this study was to evaluate the feasibility and technical success of this novel technique in standard and complex endovascular thoracic aortic repair (TEVAR).
Methods: Retrospective analysis including all consecutive patients undergoing CO reduction with MuVIT undergoing standard and fenestrated/branched TEVAR (fbTEVAR) treated in a single centre between March 1st 2020 and February 28th 2021. The target reduction of the systolic blood pressure (SBP), used as an indicator of CO reduction, was 50% from baseline 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). The primary endpoints were feasibility (MuVIT technical success), and effectiveness (procedural technical success) of the maneuver. Secondary endpoints included MuVIT related complications, procedural and at 30-days.
Results: A total of 40 patients (54% male, mean age 71 ± 11) were included, 37,5% (n=15) underwent bTEVAR, 7.5% (n=3) fTEVAR (N=3, 7,5%), and 55% (n=22) standard TEVAR.
Twenty-nine (72.5%) of the procedures were elective, seven (17.5%) were urgent and four (10%) were emergent. Precise proximal endograft deployment (technical success) 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 43.3% (Group 1: 49.1%, Group 2: 37.1%). The 30-day mortality was 7.5%, and it was unrelated to the MuVIT maneuver. Two patients with COPD Gold III and IV treated with a bTEVAR developed post-operative respiratory complications. No other major or minor MuVIT associated complications were observed.
Conclusion: MuVIT is a feasible, safe and effective maneuver for CO reduction during aortic arch TEVAR, serving as a novel alternative for other invasive techniques. However, careful patient selection is mandatory, and its potential adverse effects on severe COPD patients needs to be further evaluated.