Cerebral Protection In Circulatory Arrest Patients: The “Shaggy Aorta” Protocol
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0077
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Nicolas Chanes (1), Mohamed Eldeiry (1), Michael Kirsch (1), Bo Chang Wu (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
Mohamed Eldeiry
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University of Colorado Anschutz
University of Colorado Anschutz
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Bo Chang Wu
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective:
Although significant advances have been made in cerebral protection, embolic stroke remains a significant complication in aortic surgery. We developed the "Shaggy Aorta" protocol which combines the metabolic benefits of antegrade cerebral perfusion (ACP) with a period of under 10 minutes of retrograde cerebral perfusion (RCP) to flush out embolic debris, with a transition to ACP if the circulatory arrest time exceeds 10 minutes. We discuss the outcomes of our "Shaggy Aorta" protocol in open aortic surgery and discuss our institutional protocol for cerebral protection.
Methods: A single center prospective database was used to retrospectively evaluate patients who underwent aortic surgery with circulatory arrest. In total, 229 patients were identified since the initiation of the Shaggy protocol in December 2018. We describe pre-operative and operative characteristics, and post-operative outcomes. Furthermore, we compare the Shaggy protocol to non-Shaggy procedures in the same time period, with additional multiple logistic regression to control for potential confounds.
Results:
For the 229 patients identified, the majority were male (71.6%) and the majority of procedures were elective (80.8%). The Shaggy protocol was employed in both hemiarch and more extensive arch replacement, with most patients undergoing hemiarch (69.0%). Average circulatory arrest time was 11.1 8.5. When ACP was needed, average time was 10.9 8.8. RCP only was utilized in 107 (46.7%) of cases, with an average RCP time of 5.3 2.5. Post-operative stroke occurred in 9 patients (3.9%), with the majority occurring as a non-disabling stroke (6, 2.6%). All disabling strokes occurred in urgent/emergent procedures (3, 1.3%). When comparing to 215 non-Shaggy cases, Shaggy protocol demonstrated decreased stroke risk in univariate analysis (p<0.001), and in multiple logistic regression accounting for urgency and extent of arch replacement (OR 0.3989, CI [0.167,0.8853], p=0.0293).
Conclusions:
The "Shaggy Aorta" protocol developed by our institution significantly reduces stroke risk. When stroke did occur, it was typically non-disabling, with disabling stroke only occurring in urgent or emergent procedures. Based on our experiences with our Shaggy protocol and managing stroke, we propose a protocol for mitigating stroke risk in aortic arch surgery.
Although significant advances have been made in cerebral protection, embolic stroke remains a significant complication in aortic surgery. We developed the "Shaggy Aorta" protocol which combines the metabolic benefits of antegrade cerebral perfusion (ACP) with a period of under 10 minutes of retrograde cerebral perfusion (RCP) to flush out embolic debris, with a transition to ACP if the circulatory arrest time exceeds 10 minutes. We discuss the outcomes of our "Shaggy Aorta" protocol in open aortic surgery and discuss our institutional protocol for cerebral protection.
Methods: A single center prospective database was used to retrospectively evaluate patients who underwent aortic surgery with circulatory arrest. In total, 229 patients were identified since the initiation of the Shaggy protocol in December 2018. We describe pre-operative and operative characteristics, and post-operative outcomes. Furthermore, we compare the Shaggy protocol to non-Shaggy procedures in the same time period, with additional multiple logistic regression to control for potential confounds.
Results:
For the 229 patients identified, the majority were male (71.6%) and the majority of procedures were elective (80.8%). The Shaggy protocol was employed in both hemiarch and more extensive arch replacement, with most patients undergoing hemiarch (69.0%). Average circulatory arrest time was 11.1 8.5. When ACP was needed, average time was 10.9 8.8. RCP only was utilized in 107 (46.7%) of cases, with an average RCP time of 5.3 2.5. Post-operative stroke occurred in 9 patients (3.9%), with the majority occurring as a non-disabling stroke (6, 2.6%). All disabling strokes occurred in urgent/emergent procedures (3, 1.3%). When comparing to 215 non-Shaggy cases, Shaggy protocol demonstrated decreased stroke risk in univariate analysis (p<0.001), and in multiple logistic regression accounting for urgency and extent of arch replacement (OR 0.3989, CI [0.167,0.8853], p=0.0293).
Conclusions:
The "Shaggy Aorta" protocol developed by our institution significantly reduces stroke risk. When stroke did occur, it was typically non-disabling, with disabling stroke only occurring in urgent or emergent procedures. Based on our experiences with our Shaggy protocol and managing stroke, we propose a protocol for mitigating stroke risk in aortic arch surgery.
Aortic Symposium:
Cerebral Protection
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