Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation

Jude F. Clancy, Roger Carrillo, Ryan Sotak, Rashmi Ram, Robert K. Ryu, Charles Kennergren

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Superior vena cava (SVC) perforation is a rare but potentially fatal complication of transvenous lead removal. Objective The aim of this study was to evaluate the feasibility of hemodynamic stabilization using an occlusion balloon during SVC tear in a porcine model. Methods A surgically induced SVC perforation was created in Yorkshire cross swine (n = 7). Three animals were used to develop and test surgical repair methods. Four animals were used to evaluate hemodynamic, behavioral, and neurological effects up to 5 days after SVC tear and repair. An occlusion balloon (Bridge Occlusion Balloon, Spectranetics Corporation, Colorado Springs, CO) was percutaneously delivered through the femoral vein to the location of the injury and inflated. Once hemodynamic control was achieved, the perforation was surgically repaired. Results After SVC perforation and clamp release, the rate of blood loss was 7.0 ± 0.8 mL/s. Mean time from SVC tear to occlusion balloon deployment was 55 ± 12 seconds, during which mean arterial pressure decreased from 56 ± 2 to 25 ± 3 mm Hg and heart rate decreased from 76 ± 7 to 62 ± 7 beats/min. After the deployment of the occlusion balloon, the rate of blood loss decreased by 90%, to 0.7 ± 0.2 mL/s. The mean time of balloon occlusion of the SVC was 16 ± 4 minutes and hemodynamic measures returned to baseline levels during this time. Study animals experienced no major complications, demonstrated stable recovery, and exhibited normal neurological function at each postoperative assessment. Conclusion Endovascular temporary balloon occlusion may be a feasible option to reduce blood loss, maintain hemodynamic control, and provide a bridge to surgery after SVC injury.

Original languageEnglish (US)
Pages (from-to)2215-2220
Number of pages6
JournalHeart Rhythm
Volume13
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Balloon Occlusion
Superior Vena Cava
Swine
Hemodynamics
Femoral Vein
Wounds and Injuries
Carbon Monoxide
Arterial Pressure
Heart Rate

Keywords

  • Bridge
  • Endovascular repair
  • Occlusion balloon
  • Superior vena cava
  • Swine model

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Clancy, J. F., Carrillo, R., Sotak, R., Ram, R., Ryu, R. K., & Kennergren, C. (2016). Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation. Heart Rhythm, 13(11), 2215-2220. https://doi.org/10.1016/j.hrthm.2016.06.028

Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation. / Clancy, Jude F.; Carrillo, Roger; Sotak, Ryan; Ram, Rashmi; Ryu, Robert K.; Kennergren, Charles.

In: Heart Rhythm, Vol. 13, No. 11, 01.11.2016, p. 2215-2220.

Research output: Contribution to journalArticle

Clancy, JF, Carrillo, R, Sotak, R, Ram, R, Ryu, RK & Kennergren, C 2016, 'Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation', Heart Rhythm, vol. 13, no. 11, pp. 2215-2220. https://doi.org/10.1016/j.hrthm.2016.06.028
Clancy, Jude F. ; Carrillo, Roger ; Sotak, Ryan ; Ram, Rashmi ; Ryu, Robert K. ; Kennergren, Charles. / Percutaneous occlusion balloon as a bridge to surgery in a swine model of superior vena cava perforation. In: Heart Rhythm. 2016 ; Vol. 13, No. 11. pp. 2215-2220.
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N2 - Background Superior vena cava (SVC) perforation is a rare but potentially fatal complication of transvenous lead removal. Objective The aim of this study was to evaluate the feasibility of hemodynamic stabilization using an occlusion balloon during SVC tear in a porcine model. Methods A surgically induced SVC perforation was created in Yorkshire cross swine (n = 7). Three animals were used to develop and test surgical repair methods. Four animals were used to evaluate hemodynamic, behavioral, and neurological effects up to 5 days after SVC tear and repair. An occlusion balloon (Bridge Occlusion Balloon, Spectranetics Corporation, Colorado Springs, CO) was percutaneously delivered through the femoral vein to the location of the injury and inflated. Once hemodynamic control was achieved, the perforation was surgically repaired. Results After SVC perforation and clamp release, the rate of blood loss was 7.0 ± 0.8 mL/s. Mean time from SVC tear to occlusion balloon deployment was 55 ± 12 seconds, during which mean arterial pressure decreased from 56 ± 2 to 25 ± 3 mm Hg and heart rate decreased from 76 ± 7 to 62 ± 7 beats/min. After the deployment of the occlusion balloon, the rate of blood loss decreased by 90%, to 0.7 ± 0.2 mL/s. The mean time of balloon occlusion of the SVC was 16 ± 4 minutes and hemodynamic measures returned to baseline levels during this time. Study animals experienced no major complications, demonstrated stable recovery, and exhibited normal neurological function at each postoperative assessment. Conclusion Endovascular temporary balloon occlusion may be a feasible option to reduce blood loss, maintain hemodynamic control, and provide a bridge to surgery after SVC injury.

AB - Background Superior vena cava (SVC) perforation is a rare but potentially fatal complication of transvenous lead removal. Objective The aim of this study was to evaluate the feasibility of hemodynamic stabilization using an occlusion balloon during SVC tear in a porcine model. Methods A surgically induced SVC perforation was created in Yorkshire cross swine (n = 7). Three animals were used to develop and test surgical repair methods. Four animals were used to evaluate hemodynamic, behavioral, and neurological effects up to 5 days after SVC tear and repair. An occlusion balloon (Bridge Occlusion Balloon, Spectranetics Corporation, Colorado Springs, CO) was percutaneously delivered through the femoral vein to the location of the injury and inflated. Once hemodynamic control was achieved, the perforation was surgically repaired. Results After SVC perforation and clamp release, the rate of blood loss was 7.0 ± 0.8 mL/s. Mean time from SVC tear to occlusion balloon deployment was 55 ± 12 seconds, during which mean arterial pressure decreased from 56 ± 2 to 25 ± 3 mm Hg and heart rate decreased from 76 ± 7 to 62 ± 7 beats/min. After the deployment of the occlusion balloon, the rate of blood loss decreased by 90%, to 0.7 ± 0.2 mL/s. The mean time of balloon occlusion of the SVC was 16 ± 4 minutes and hemodynamic measures returned to baseline levels during this time. Study animals experienced no major complications, demonstrated stable recovery, and exhibited normal neurological function at each postoperative assessment. Conclusion Endovascular temporary balloon occlusion may be a feasible option to reduce blood loss, maintain hemodynamic control, and provide a bridge to surgery after SVC injury.

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