The Munich Valsalva Implantation Technique (MuVIT) for Cardiac Output Reduction During TEVAR: Vena Cava Occlusion With the Valsalva Maneuver

• Published in: Journal of endovascular therapy Vol. 28; no. 1; p. 7
• Main Authors: Tsilimparis, Nikolaos, Abicht, Jan-Michel, Stana, Jan, Konstantinou, Nikolaos, Rantner, Barbara, Banafsche, Ramin, Fernandez Prendes, Carlota
• Format: Journal Article
• Language: English
• Published: United States 01.02.2021
• Subjects: Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Cardiac Output; Endovascular Procedures - adverse effects; Humans; Prosthesis Design; Stents; Treatment Outcome; Valsalva Maneuver; cardiac output; vena cava occlusion; thoracic endovascular aortic repair; deployment techniques; positive end-expiratory pressure; stent-graft; endograft; aortic arch
• ISSN: 1545-1550
• DOI: 10.1177/1526602820961376

To demonstrate a physiologically induced alternative to the typical methods of reducing cardiac output during deployment of stent-grafts in the aortic arch and proximal aorta. A modified Valsalva maneuver, the Munich Valsalva implantation technique (MuVIT), to raise the intrathoracic pressure, minimize backflow, and reduce the cardiac output is illustrated in a patient undergoing a triple-branch thoracic endovascular aortic repair (TEVAR). During manual mechanical ventilation, the adjustable pressure-limiting valve is carefully closed to 25 mm Hg, creating "manual bloating" of the lungs and sustained apnea. The increased intrathoracic pressure causes compression of the vena cava and pulmonary veins, reducing the venous backflow and gradually decreasing the arterial pressure. Once the desired pressure is obtained, the stent-graft is accurately deployed. The airway pressure is thereupon slowly reduced, and the patient is taken back to normal ventilation. The procedure is then finished following standard practice. The MuVIT is a simple, noninvasive technique for cardiac output reduction during aortic arch TEVAR, eliminating the need for other invasive techniques.