Rapid Ventricular Transvenous Pacing via Pulmonary Artery Catheter: Deliberate Hypotension Technique for Precise Proximal Thoracic Aortic Stent Graft Deployment

Deliberate hypotension facilitates precise deployment of endovascular stent grafting in the thoracic aorta. We describe a practical technique using pulmonary artery catheter (PAC) guided transvenous rapid ventricular pacing via transjugular approach and delineate pertinent anesthetic considerations. Anesthesiologists performed PAC guided rapid ventricular pacing in thirty-nine (39) patients (27 men and 12 women, mean age 74 11 years) undergoing thoracic endograft deployment for aneurysm repair. Patient characteristics, hemodynamic parameters, pacing rate, and number of pacing events were recorded. Post-operative complications were evaluated. PAC guided rapid ventricular pacing successfully provided controlled hypotension without technical complications. Mean pacing rate was 177 17 beats/min with an average of 2.6 2 pacing events/surgical procedure. Average pacing duration was 34 29 seconds (MAP of 47 5 mmHg). One intraoperative death occurred in a patient with severe valvular heart disease. In all other cases, recovery time to baseline hemodynamics was short. Postoperative complications included atrial fibrillation in five patients (12%), elevated troponin levels in eight (21%), and stroke in three (8%). No patients had PAC related complications.