From the Guidelines
After thoracic aortic aneurysm repair, the target heart rate should be 60 beats per minute or less, and systolic blood pressure should be maintained at 120 mm Hg or less, with the goal of reducing aortic wall stress and preventing complications such as hypotension and tachycardia. To achieve these targets, intravenous beta blockade should be initiated and titrated, with alternatives such as nondihydropyridine calcium channel-blocking agents used in patients with contraindications to beta blockade 1. Key considerations for management include:
- Initial heart rate control using beta blockers, with a target heart rate of 60 beats per minute or less 1
- Use of angiotensin-converting enzyme inhibitors and/or other vasodilators to further reduce blood pressure if systolic blood pressures remain greater than 120 mm Hg after adequate heart rate control has been obtained 1
- Cautious use of beta blockers in the setting of acute aortic regurgitation, as they can block compensatory tachycardia 1 By maintaining strict hemodynamic control and monitoring patients closely, the risk of complications such as hypotension and tachycardia can be minimized, and the overall outcome for patients after thoracic aortic aneurysm repair can be improved.
From the Research
Target Ranges for Heart Rate and Blood Pressure
To prevent complications such as hypotension and tachycardia after thoracic aortic aneurysm repair, it is essential to maintain specific target ranges for heart rate and blood pressure. The following points highlight the key findings:
- The target range for mean arterial pressure is 90 mmHg or greater, as stated in the study 2.
- Systolic blood pressure should be controlled below 120 mmHg, as mentioned in the study 3.
- The study 4 found that beta-blockade with metoprolol was effective in controlling systolic blood pressure and heart rate both intraoperatively and postoperatively in patients undergoing repair of abdominal aortic aneurysm.
- Peak exercise systolic and diastolic blood pressures were 160 mm Hg and 70 mm Hg, respectively, with no differences noted between groups, as reported in the study 5.
Preventing Complications
Preventing complications such as hypotension and tachycardia is crucial after thoracic aortic aneurysm repair. The following points highlight the key findings:
- The use of nicardipine hydrochloride as antihypertensive therapy before and after surgery was found to be effective, with few side effects, as stated in the study 6.
- Beta-blockade with metoprolol was found to significantly reduce the incidence of perioperative myocardial infarction and arrhythmias, as reported in the study 4.
- Early detection and intervention to augment spinal cord perfusion pressure was effective for decreasing the magnitude of injury or preventing permanent paraplegia from spinal cord ischemia after endovascular stent repair of descending thoracic aortic aneurysm, as mentioned in the study 2.
- Postoperative initial 2-day blood pressure management had a preventive effect on AAA sac enlargement until midterm periods, by reducing the incidence of type II endoleak at 7 days after EVAR, as stated in the study 3.