Chow Christopher Yu, Montoya Christopher, Sussman Matthew, Kenel-Pierre Stefan, Velazquez Omaida Caridad, Grazette Luanda, Shao Tony
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Miami, Miami, FL.
Division of Cardiovascular Medicine, University of Miami Health System, Miami, FL.
J Vasc Surg Cases Innov Tech. 2024 Feb 24;10(6):101464. doi: 10.1016/j.jvscit.2024.101464. eCollection 2024 Dec.
Baroreflex activation therapy (BAT) is an emerging device-based treatment for patients with heart failure with a reduced ejection fraction refractory to maximally tolerated goal-directed medical therapy. Currently, there is sparse literature on the critical role that vascular surgeons serve in the delivery of this novel therapy. This single-institution series describes the creation of a BAT program and elaborates on the function of vascular surgeons in the multidisciplinary heart failure team. The preoperative evaluation, perioperative care, and postoperative course of patients receiving BAT from March 2022 to August 2023 were retrospectively analyzed. Eleven patients were evaluated by a dedicated heart failure cardiologist for medical eligibility and assessed by a vascular surgeon for technical feasibility. Of the 11 patients, 7 were men (63.6%). The median age was 60.5 years (range, 44-73 years). No patient (0.00%) had existing carotid artery disease, and one patient (9.1%) had undergone previous neck radiation therapy. All 11 patients (100%) had an existing cardiac implantable electronic device, and BAT implantation was performed on the same side as the cardiac implantable electronic device in two patients (18.1%). Four patients (36.4%) required preoperative hospital admission for medical optimization before surgery. The median length of surgery was 82 minutes (range, 58-113 minutes), and the median length of stay in the hospital after surgery was 1 day (range, 0-6 days). No major adverse neurologic or cardiovascular events, cranial nerve injuries, device complications requiring reintervention, or heart failure-related mortality at 6 months occurred. Three patients (27.3%) experienced extraneous stimulations, which affected BAT tolerability. Within 6 months after BAT implantation, no significant improvements were observed for several heart failure disease burden markers compared with 6 months before BAT implantation. Our early results demonstrate that BAT implantation is a safe procedure with rare complications. Vascular surgeons play an important role in the multidisciplinary delivery of this novel device-based therapy. More data are needed to understand whether BAT is beneficial in the treatment of heart failure with a reduced ejection fraction refractory to maximally tolerated goal-directed medical therapy.
压力反射激活疗法（BAT）是一种新兴的基于设备的治疗方法，用于治疗射血分数降低的心力衰竭患者，这些患者对最大耐受的目标导向药物治疗无效。目前，关于血管外科医生在提供这种新疗法中所起的关键作用的文献很少。这个单机构系列描述了一个BAT项目的创建，并详细阐述了血管外科医生在多学科心力衰竭团队中的作用。对2022年3月至2023年8月接受BAT治疗的患者的术前评估、围手术期护理和术后病程进行了回顾性分析。11名患者由专门的心力衰竭心脏病专家评估其医疗适宜性，并由血管外科医生评估其技术可行性。11名患者中，7名男性（63.6%）。中位年龄为60.5岁（范围44 - 73岁）。没有患者（0.00%）患有现有的颈动脉疾病，1名患者（9.1%）曾接受过颈部放射治疗。所有11名患者（100%）都有现有的心脏植入式电子设备，2名患者（18.1%）的BAT植入与心脏植入式电子设备在同一侧进行。4名患者（36.4%）在手术前需要住院进行医疗优化。中位手术时间为82分钟（范围58 - 113分钟），术后中位住院时间为1天（范围0 - 6天）。6个月时未发生重大不良神经或心血管事件、颅神经损伤、需要再次干预的设备并发症或心力衰竭相关死亡。3名患者（27.3%）经历了外部刺激，这影响了BAT的耐受性。与BAT植入前6个月相比，在BAT植入后6个月内，几种心力衰竭疾病负担标志物没有观察到显著改善。我们的早期结果表明，BAT植入是一种安全的手术，并发症罕见。血管外科医生在这种基于新设备的疗法的多学科实施中发挥着重要作用。需要更多数据来了解BAT是否有益于治疗射血分数降低且对最大耐受的目标导向药物治疗无效的心力衰竭。
