Acute Successful Baroreceptor Activation Therapy for Uncontrolled Arterial Hypertension in Two Post–Aortic Dissection Patients

Objectives: Baroreceptor activation therapy (BAT) significantly reduces blood pressure in patients with therapy-refractory arterial hypertension. BAT implantation is usually performed as an elective procedure and the system is activated 2 weeks after implantation to allow for wound healing. We herein describe two patients in whom BAT implantation and early activation was performed as an urgent therapy within 2 weeks after surgery for Type A and Type B aortic dissection due to therapy-refractory arterial hypertension to prevent hypertensive crisis and aortic complications.

Methods: The first patient was a 54-year-old male, treated for Type B aortic dissection by thoracic endovascular aortic repair. The BAT device was implanted 12 days later followed by activation after 2 days. Patient 2 (male, age 60) underwent ascending aortic replacement for Type A dissection and underwent BAT implantation 2 weeks later with activation on postoperative day 2. Blood pressure measurements were recorded in hospital during the postoperative course and 24-hour blood pressure monitoring was performed in the follow-up.

Results: In both patients, BAT implantation was uneventful and activation 2 days later was successful. The healing process was not impaired in both patients. In patient 1, mean blood pressure level dropped from 170/90 mm Hg pre-BAT to 140/80 mm Hg under regular daily activity at 3-month follow-up. Patient 2 showed a decrease in blood pressure from 160/75 mm Hg pre-BAT to 130/75 mm Hg at latest follow-up. Antihypertensive medication could be reduced by 1 in both patients.

Conclusion: We describe two cases of BAT implantation as an urgent procedure for drug-resistant arterial hypertension early after surgery for Type A and Type B aortic dissection. Immediate activation of the system is safe, helps avoiding life-threatening hypertensive crisis and might prevent aortic complications in that specific group of patients.

No conflict of interest has been declared by the author(s).