Abstract 20935: Improving Spinal Cord Protection During the Frozen Elephant Trunk Technique: Effect of a Dedicated Neuroprotection Protocol

Abstract

Introduction: The frozen elephant trunk (FET) technique may be complicated by a risk of spinal cord injury (SCI) which has been reported as high as 10%.Precise mechanisms responsible for SCI after FET are still unclear and so the best protection strategy to avoid it. Hypothesis: We aim to review our experience with a specific protocol developed to reduce the risk of SCI during open surgery of the descending aorta applied to patients operated with FET in order to increase spinal cord protection Methods: Spinal cord protection protocol included: 1.Careful preoperative planning to deploy of stent above the level of the 10th thoracic vertebra and preserving the patency of the left subclavian artery; 2.Postoperative management with goal directed therapy aimed to achieve mean systemic blood pressure between 85 and 105 mmHg, cardiac index >2.4 l/min/m2, urine output >1 ml/Kg/min, a base excess of 0±5, a pH>7.3 and haemoglobin level >10 g/dl; 3.Cerebrospinal fluid (CSF) drainage was used in 4 patients (5.8%) only Results: From April 2006 to December 2015 69 patients underwent aortic repair with the FET at our Institution.There were 31 males (51.7%). Median [IQR] age was 69 [59-75] years and median [IQR] Log EuroSCORE was 20.3 [13.9-36.2]. There were 19 (27.5%) reoperations. Operative times and outcomes are reported in Table 1. Conclusions: SCI remains the Achilles’ heel of the FET procedure.Elevated blood pressure in the preoperative period may reduce the risk of SCI by increasing the collateral network remodeling.Careful preoperarative planning and avoidance of sacrifice of all thoracic segmental arteries and preservation of left subclavian artery patency may reduce the risk of SCI maintaining good collateralization of the spinal cord perfusion network.Attention to all haemodynamic and metabolic parameters may avoid further ischemic insults to the spinal cord. CSF drainage may not be necessary in all cases of FET