Spinal Cord Protection for Open Descending Thoracic and Thoracoabdominal Aorta Surgery: An STS Adult Cardiac Surgery Database Analysis.

Background: Spinal cord injury (SCI) is a devastating complication of open descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA). We evaluated the efficacy of spinal drain placement on spinal injury in DTAA/TAAA repair.

Methods: Adult patients (>18 years) undergoing open DTAA/TAAA repair without aortic root, ascending or arch involvement were identified from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2017-2023). Cases were excluded if preoperative paralysis, postoperative spinal drain placement; or if patient expired in the operating theater. Primary SCI outcomes were 1) lower extremity paralysis lasting >24 hours, and 2) a composite of paralysis and/or paresis lasting >24 hours. Multivariable logistic regression models with adjustment for patient, intraoperative, and aortic disease factors were derived to evaluate the role of spinal drain placement in DTAA and TAAA repair.

Results: The study population included 2,724 patients from 224 hospitals who underwent DTAA (n=813; 61.3% spinal drain) or TAAA (n=1,911; 75.2% spinal drain) repairs. Observed rates of SCI were distinctly higher for TAAA versus DTAA repairs (paralysis: 7.3% vs. 1.9%, p<0.001; paralysis/paresis: 10.3% vs. 3.0%; p<0.001). Spinal drain was independently associated with increased paralysis (adjusted odds ratios [AOR (95% Confidence Intervals)]=3.63 [1.94-6.80], p<0.001) and paralysis/paresis (AOR=2.51 [1.58-4.00], p<0.001) in TAAA repair but not DTAA.

Conclusions: An unexpected association was found between spinal drain use and increased spinal injury. We hypothesize that spinal drain use may indicate higher risk anatomy as opposed to being a causative factor of spinal cord injury.