IMPACT OF CEREBRAL PERFUSION STRATEGIES ON NEUROLOGICAL OUTCOMES IN AORTIC ARCH REPAIR USING THE FROZEN ELEPHANT TRUNK TECHNIQUE

Abstract

This study aimed to evaluate the impact of various cerebral perfusion strategies on neurological outcomes, comparing our results on trilateral antegrade cerebral perfusion (tACP) to reported rates from latest literature analysis on bilateral antegrade cerebral perfusion (bACP) and unilateral antegrade cerebral perfusion (uACP). Methods: A retrospective analysis was performed on 15 patients who underwent surgical intervention at the University Clinic for Cardiac Surgery in Skopje between 2018 and 2023. All patients included had elective chronic aortic dissections. Preoperative evaluation encompassed a detailed medical history, physical examination, diagnostic imaging, and risk stratification using the EuroSCORE II model. Standardized surgical techniques, including trilateral cerebral perfusion, were employed intraoperatively. The primary endpoint was the incidence of major neurological complications, including stroke and SCI, while the secondary endpoint was all-cause mortality. Results: Major neurological events, including stroke and transient ischemic attack (TIA), were observed in 6.7% of patients, with SCI occurring in a single case (6.7%). These rates are notably lower than previously reported figures of 5-15% for procedural strokes following complex aortic arch repairs employing uACP or bACP. All-cause mortality in our cohort was 20%, compared to the 31% reported in the literature for patients undergoing open aortic arch repair. Conclusion: In patients undergoing total aortic arch repair with the FET technique, tACP appears to be a viable strategy for cerebral and spinal cord protection. The complication rates observed in our cohort are favorable and support further investigation with larger patient populations to validate these findings.