From the Guidelines
During thoracic aortic aneurysm repair, the target heart rate should be 60 beats per minute or less, and blood pressure should be controlled to maintain adequate end-organ perfusion, with systolic blood pressures ideally less than 120 mm Hg. This is based on the 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease 1. The guidelines recommend initiating intravenous beta blockade to achieve a target heart rate of 60 beats per minute or less, and using angiotensin-converting enzyme inhibitors and/or other vasodilators to further reduce blood pressure if necessary.
- Key considerations for blood pressure control include:
- Maintaining systolic blood pressures less than 120 mm Hg
- Using intravenous beta blockade as the first line of treatment
- Adding angiotensin-converting enzyme inhibitors and/or other vasodilators as needed to maintain adequate end-organ perfusion
- It is also important to note that beta blockers should be used cautiously in the setting of acute aortic regurgitation, as they can block the compensatory tachycardia 1.
- The choice of specific medications and dosages may vary depending on the patient's individual needs and response to treatment, but the overall goal is to reduce aortic wall stress by controlling heart rate and blood pressure.
- Monitoring should continue postoperatively, with gradual liberalization of targets as the repair stabilizes, to minimize the risk of complications and promote optimal outcomes.
From the Research
Target Heart Rate and Blood Pressure Ranges
- The target heart rate and blood pressure ranges for thoracic aortic aneurysm repair are not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that maintaining stable hemodynamics is crucial during thoracic aortic aneurysm repair to prevent complications such as hypotension and tachycardia 3, 4, 5.
- The use of vasoconstrictors, such as phenylephrine and norepinephrine, is common to maintain arterial blood pressure at target levels during treatment 4.
- The studies also highlight the importance of careful hemodynamic management, including the use of beta-blockers, to control heart rate and prevent complications 2, 4.
Hemodynamic Management
- Hemodynamic management during thoracic aortic aneurysm repair involves maintaining a balance between blood pressure, cardiac output, and vascular resistance 3, 4, 5.
- The use of left heart bypass, cerebrospinal fluid drainage, and segmental intercostal or lumbar artery reattachment are common strategies to prevent ischemic complications during repair 3, 5.
- The studies suggest that a multimodal approach, including careful patient selection, surgical technique, and perioperative care, is essential to minimize morbidity and mortality during thoracic aortic aneurysm repair 3, 5, 6.