Journal of cardiothoracic and vascular anesthesia, 29 5 2025, Pages S1053-0770(25)00272-1 Anesthesia Management for the Personalized External Aortic Root Support (PEARS) Procedure: A Single-Center Experience. Pandey AK, Kougioumtzoglou AM, Lam BCY, Kho E, Eberl S, Dilai J, Koolbergen DR, Hermanns H
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.
