TY - JOUR
T1 - Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease
AU - Piffaretti, Gabriele
AU - Bonardelli, Stefano
AU - Bellosta, Raffaello
AU - Mariscalco, Giovanni
AU - Lomazzi, Chiara
AU - Tolenaar, Jip L.
AU - Zanotti, Camilla
AU - Guadrini, Cristina
AU - Sarcina, Antonio
AU - Castelli, Patrizio
AU - Trimarchi, Santi
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objectives: The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease.Methods:We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair.Results: Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P = .046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P = .057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80% ± 5%, 68% ± 6%, and 63% ± 7%, respectively. Spinal cord injury did not impair survival (P = .885).Conclusions: In our experience, the risk of spinal cord injury is still substantial at 8%in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia.
AB - Objectives: The aim of the present study is to report a risk analysis for spinal cord injury in a recent cohort of patients with simultaneous and sequential treatment of multilevel aortic disease.Methods:We performed a multicenter study with a retrospective data analysis. Simultaneous treatment refers to descending thoracic and infrarenal aortic lesions treated during the same operation, and sequential treatment refers to separate operations. All descending replacements were managed with endovascular repair.Results: Of 4320 patients, multilevel aortic disease was detected in 77 (1.8%). Simultaneous repair was performed in 32 patients (41.5%), and a sequential repair was performed in 45 patients (58.4%). Postoperative spinal cord injury developed in 6 patients (7.8%). At multivariable analysis, the distance of the distal aortic neck from the celiac trunk was the only independent predictor of postoperative spinal cord injury (odds ratio, 0.75; 95% confidence interval, 0.56-0.99; P = .046); open surgical repair of the abdominal aortic disease was associated with a higher risk of spinal cord injury but did not reach statistical significance (odds ratio, 0.16; 95% confidence interval, 0.02-1.06; P = .057). Actuarial survival estimates at 1, 2, and 5 years after the procedure were 80% ± 5%, 68% ± 6%, and 63% ± 7%, respectively. Spinal cord injury did not impair survival (P = .885).Conclusions: In our experience, the risk of spinal cord injury is still substantial at 8%in patients with multilevel aortic disease. The distance of the distal landing zone from the celiac trunk is a significant predictor of spinal cord ischemia.
UR - http://www.scopus.com/inward/record.url?scp=84908253978&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908253978&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2014.02.062
DO - 10.1016/j.jtcvs.2014.02.062
M3 - Article
C2 - 24698563
AN - SCOPUS:84908253978
SN - 0022-5223
VL - 148
SP - 1435-1442.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -