New frontiers in aortic therapy: Focus on deliberate hypotension during thoracic aortic endovascular interventions

摘要

THORACIC AORTIC ENDOVASCULAR interventions have blossomed in recent years and have progressed around the aortic arch all the way to replacement of the aortic valve. The entire thoracic aorta is now amenable to endovas-cular repair in selected patients. These transcatheter procedures frequently require brief deliberate hypotension to facilitate precise hardware deployment. The described techniques for deliberate hypotension in these settings include nitrovasodila-tors, adenosine, balloon vena cava occlusion and rapid ventricular pacing. Rapid ventricular pacing has evolved to become the current gold standard in the contemporary era due to its efficacy, predictability, consistency, rapid reversibility, and potential to assist in hemodynamic recovery after endovascular device deployment. Further clinical trials will likely explore alternatives in the setting of this current clinical paradigm.