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

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-03-29 DOI:10.1053/j.jvca.2025.03.047

Anil K. Pandey MD , Athiná M. Kougioumtzoglou MD , Bobby C.Y. Lam BSc , Eline Kho MSc , Susanne Eberl MD, PhD , José Dilai MSc , Dave R. Koolbergen MD, PhD , Henning Hermanns MD, PhD

{"title":"Anesthesia Management for the Personalized External Aortic Root Support (PEARS) Procedure: A Single-Center Experience","authors":"Anil K. Pandey MD , Athiná M. Kougioumtzoglou MD , Bobby C.Y. Lam BSc , Eline Kho MSc , Susanne Eberl MD, PhD , José Dilai MSc , Dave R. Koolbergen MD, PhD , Henning Hermanns MD, PhD","doi":"10.1053/j.jvca.2025.03.047","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To delineate anesthesia management during the personalized external aortic root support (PEARS) procedure, with a focus on the use of multimodal monitoring and deliberate profound hypotension.</div></div><div><h3>Design</h3><div>A single-center retrospective cohort study.</div></div><div><h3>Setting</h3><div>Tertiary academic hospital.</div></div><div><h3>Participants</h3><div>Patients undergoing the PEARS procedure due to aortic aneurysm.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Methods</h3><div>Patient characteristics and anesthesia management are described, with particular emphasis on multimodal hemodynamic, cerebral monitoring, and transesophageal echocardiography during the deliberate profound hypotension phase during the isolated PEARS procedure.</div></div><div><h3>Results: Seventy-three</h3><div>patients underwent an isolated PEARS procedure in an academic hospital in The Netherlands between January, 2018, and December, 2023. Fifty-six patients were male (72.2%), and the mean patient age was 38 ± 15.7 years. Five patients required conversion to cardiopulmonary bypass. There were no in-hospital deaths, myocardial infarction, stroke, major bleeding, reoperation for any cause, prosthesis infection, or postoperative delirium. Postoperative atrial fibrillation occurred in 11 patients (15.1%). The mean duration of intensive care unit admission was 1.3 days, and the mean hospital length of stay was 7.6 days. All procedures were performed by a single surgeon.</div></div><div><h3>Conclusions</h3><div>The PEARS procedure appears to be a viable alternative for preventive replacement of the aorta in selected patients with aortic aneurysms. Anesthesia is safe; in particular, profound deliberate hypotension can be used without relevant complications using multimodal monitoring, with electroencephalographic burst suppression as the guiding factor for cerebral perfusion. As published by other groups, PEARS has excellent outcomes in experienced centers.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"39 7","pages":"Pages 1681-1688"},"PeriodicalIF":2.3000,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1053077025002721","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To delineate anesthesia management during the personalized external aortic root support (PEARS) procedure, with a focus on the use of multimodal monitoring and deliberate profound hypotension.

Design

A single-center retrospective cohort study.

Setting

Tertiary academic hospital.

Participants

Patients undergoing the PEARS procedure due to aortic aneurysm.

Interventions

None.

Methods

Patient characteristics and anesthesia management are described, with particular emphasis on multimodal hemodynamic, cerebral monitoring, and transesophageal echocardiography during the deliberate profound hypotension phase during the isolated PEARS procedure.

Results: Seventy-three

patients underwent an isolated PEARS procedure in an academic hospital in The Netherlands between January, 2018, and December, 2023. Fifty-six patients were male (72.2%), and the mean patient age was 38 ± 15.7 years. Five patients required conversion to cardiopulmonary bypass. There were no in-hospital deaths, myocardial infarction, stroke, major bleeding, reoperation for any cause, prosthesis infection, or postoperative delirium. Postoperative atrial fibrillation occurred in 11 patients (15.1%). The mean duration of intensive care unit admission was 1.3 days, and the mean hospital length of stay was 7.6 days. All procedures were performed by a single surgeon.

Conclusions

The PEARS procedure appears to be a viable alternative for preventive replacement of the aorta in selected patients with aortic aneurysms. Anesthesia is safe; in particular, profound deliberate hypotension can be used without relevant complications using multimodal monitoring, with electroencephalographic burst suppression as the guiding factor for cerebral perfusion. As published by other groups, PEARS has excellent outcomes in experienced centers.

查看原文本刊更多论文

个性化主动脉外根支持（梨）手术的麻醉管理：单中心经验。

目的：描述个性化主动脉外根支持（pear）手术中的麻醉管理，重点是多模式监测和故意深度低血压的使用。设计：单中心回顾性队列研究。单位：三级专科医院。参与者：因主动脉瘤而接受梨手术的患者。干预措施:没有。方法：描述患者特征和麻醉管理，特别强调在分离梨手术中故意深度低血压阶段的多模态血流动力学、脑监测和经食管超声心动图。结果：2018年1月至2023年12月期间，73名患者在荷兰一家学术医院接受了孤立的梨手术。男性56例（72.2%），平均年龄38±15.7岁。5名患者需要转行体外循环。无院内死亡、心肌梗死、中风、大出血、因任何原因再次手术、假体感染或术后谵妄。术后发生房颤11例（15.1%）。重症监护病房的平均住院时间为1.3天，平均住院时间为7.6天。所有手术均由一名外科医生完成。结论：对于特定的主动脉瘤患者，pear手术似乎是预防性主动脉置换术的可行选择。麻醉是安全的；特别是，采用多模态监测，以脑电图脉冲抑制作为脑灌注的指导因素，可以采用深度故意降压，无相关并发症。正如其他团体发表的，pear在有经验的中心取得了很好的效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.