Vacas Lab
Email: PerioperativeBrainHealth@massgeneralbrigham.org
Call: 617-643-4478
Overview
The Vacas Laboratory aims to develop innovative preventive strategies and therapeutic targets that enhance perioperative brain health and recovery. Our work integrates molecular, physiologic, and clinical approaches to examine how biomarkers influence cognitive and functional outcomes after surgery. By identifying mechanisms of vulnerability and resilience, we aim to enable targeted interventions that mitigate the impact of surgical and anesthetic stress and improve postoperative outcomes.
Research Projects
Perioperative Cognitive Trajectories Study
Although millions of older adults undergo surgery annually in the United States, clinicians remain unable to predict which individuals will develop persistent cognitive decline and which will recover fully. This variability reflects a fundamental feature of aging: heterogeneity in brain vulnerability and resilience to physiologic stressors. In this study, we integrate genetic profiling, continuous physiologic monitoring, and longitudinal cognitive phenotyping to characterize perioperative cognitive trajectories. By combining markers of neurodegeneration with objective measures of sleep and physiologic recovery, this work advances a novel framework to understand how aging biology shapes postoperative cognitive outcomes.
Creatine Intervention in Older Adults to Improve Perioperative Brain Health (CREATE trial)
Surgery and anesthesia impose significant physiologic stress, triggering inflammatory responses and protein catabolism that affect the central nervous and musculoskeletal systems. Older adults and APOE-ε4 allele carriers often exhibit reduced bioenergetic reserve and lower creatine availability, further compromising neuronal resilience. This study evaluates whether creatine supplementation can enhance resilience to perioperative stressors. By targeting bioenergetic pathways and inflammation, the CREATE trial aims to improve brain health and overall recovery in older surgical patients.
Research Team
Susana Vacas, MD, PhD
Associate Professor of Anesthesia
Susana Vacas is a neuroanesthesiologist and physician-scientist at Mass General Brigham and Associate Professor of Anaesthesia at Harvard Medical School. Her work focuses on translating mechanistic insights into pragmatic, patient-centered care pathways. Across her professional trajectory, she has advanced the understanding of perioperative neurocognitive disorders and contributed to large-scale brain health initiatives through a sustained research program aimed at improving postoperative brain health and recovery. By integrating molecular biology, novel monitoring technologies, large-scale data, and cognitive phenotyping, she develops strategies to enhance outcomes for surgical patients.
Mariana Thedim, MD
Research Fellow
Mariana Thedim is a Research Fellow at Massachusetts General Hospital, Harvard Medical School. She focuses on patients' cognitive trajectories and on identifying potential biomarkers that indicate increased vulnerability to surgery and anesthesia. Dr. Thedim's goal is to contribute to the unraveling of the intricacies of perioperative neurocognitive disorders, aiming to help establish new targets for their prevention and management.
Arthur Formanek, MD
Instructor in Anaesthesia
Dr. Formanek is a staff anesthesiologist and intensivist at Mass General Brigham and an Instructor in Anesthesiology at Harvard Medical School. He specializes in perioperative care and critical care medicine, with a clinical focus on managing complex surgical patients and critically ill individuals in the intensive care unit. Dr. Formanek has authored chapters on several regional anesthetic techniques and has been recognized by his department with an Award in Excellence.
Jeanine Wiener-Kronish, MD
Dr. Wiener-Kronish is the Distinguished Henry Isaiah Dorr Professor of Research and Teaching in Anaesthetics and Anaesthesia at Harvard Medical School and was previously the Anesthetist-in-Chief at Massachusetts General Hospital between April 2008 and December 2019. Over the course of her career, she has advanced the understanding of how physiological stressors associated with surgery and critical illness affect patient outcomes, with a particular emphasis on lung injury, inflammation, and perioperative organ dysfunction.