Abstract Details

Title Defying the Odds: Complete Cerebral Rescue and Neuroprotection after Frozen Elephant Trunk Repair

Topic Neuro Trauma and Critical Care

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 19-003

Objective

To illustrate that a structured, physiology-driven neuroprotection protocol can achieve complete cerebral rescue during extensive FET repair in a young patient with acute Stanford type A dissection.

Background Cerebral protection during aortic arch surgery remains one of the most formidable challenges in perioperative neurology. Even transient global ischemia can trigger irreversible neuronal loss, cognitive decline, and microstructural white matter injury. Modern neuroprotective strategies deep hypothermia, selective antegrade cerebral perfusion (SACP), and multimodal neuromonitoring aim to maintain perfusion metabolism balance and prevent excitotoxicity during circulatory arrest. The Frozen Elephant Trunk (FET) procedure, though primarily a cardiovascular intervention, presents an extraordinary setting to test the limits of cerebral resilience and neuroprotection.

Design/Methods

A 38-year-old man with ankylosing spondylitis presented with acute Stanford type A dissection involving the root, arch, and descending thoracic aorta. Surgery included valve-sparing root replacement (David procedure), total arch replacement with FET, and coronary button reimplantation. Deep hypothermic circulatory arrest (20 °C) combined with bilateral SACP and continuous EEG/NIRS neuromonitoring maintained cerebral oxygenation and synaptic stability throughout.

Results Intraoperative cerebral perfusion remained stable. Postoperatively, the patient developed refractory cardiogenic shock requiring VA-ECMO for four days, yet neurologic monitoring remained reassuring. MRI demonstrated no infarction or hypoxic injury. The patient achieved full cognitive and motor recovery and remained neurologically intact at three-month follow-up.

Conclusions This case exemplifies that integrated, physiology-based neuroprotection can defy expected cerebral compromise even in extreme ischemic scenarios. Deep hypothermia, SACP, and real-time neuromonitoring allowed complete aortic reconstruction while preserving neurologic function. These strategies should be considered standard in high-risk aortic surgery, particularly for young patients where long-term cerebral preservation is critical.

Authors/Disclosures
Igor A. Villacis Escobar, MD PRESENTER	Mr. Villacis Escobar has nothing to disclose.
Ivana A. Garrido	Ms. Garrido has nothing to disclose.
Pamela Balda	Dr. Balda has nothing to disclose.
Estefania Balda Desiderio	Dr. Balda Desiderio has nothing to disclose.
Jorge E. Alonso, MD	Dr. Alonso has nothing to disclose.
Israel F. Rosero Basurto	Mr. Rosero Basurto has nothing to disclose.
Xiu L. Wong, MD	Dr. Wong has nothing to disclose.
Ines Baquerizo, MD	Miss Baquerizo has nothing to disclose.
Romina Andrade, Student	Miss Andrade has nothing to disclose.
Efrain I. Paredes, MD	Mr. Paredes has nothing to disclose.

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