Anesthesia Management for the Personalized External Aortic Root Support (PEARS) Procedure: A Single-Center Experience

Area of Science:

• Cardiovascular Surgery
• Anesthesiology
• Aortic Aneurysm Management

Background:

• Aortic aneurysms pose significant risks, necessitating advanced surgical interventions.
• Personalized External Aortic Root Support (PEARS) offers a less invasive alternative for aortic root support.
• Optimal anesthesia management is crucial for the success of complex cardiovascular procedures like PEARS.

Purpose of the Study:

• To detail the anesthesia management strategies employed during the PEARS procedure.
• To evaluate the safety and efficacy of deliberate profound hypotension in PEARS.
• To highlight the role of multimodal monitoring in ensuring patient safety and optimal cerebral perfusion.

Main Methods:

• Retrospective cohort study at a tertiary academic hospital.
• Analysis of patient characteristics and anesthesia protocols for PEARS procedures.
• Emphasis on multimodal hemodynamic, cerebral monitoring, and transesophageal echocardiography during deliberate profound hypotension.

Main Results:

• Seventy-three patients underwent isolated PEARS, with a mean age of 38 years; 72.2% were male.
• No in-hospital deaths, myocardial infarction, stroke, or major bleeding occurred.
• Low rates of postoperative complications including atrial fibrillation (15.1%); mean ICU stay was 1.3 days.

Conclusions:

• The PEARS procedure is a viable option for selected patients with aortic aneurysms.
• Anesthesia management, including deliberate profound hypotension guided by electroencephalographic burst suppression, is safe and effective.
• PEARS demonstrates excellent outcomes in experienced centers, underscoring the importance of specialized surgical and anesthetic care.