Protective Effect on Spinal Cord Injury of Prophylactic Cerebrospinal Fluid Drainage in Extensive Aortic Arch Repair for Type A Aortic Dissection: A Retrospective Cohort Study

被引:0
|
作者
Zhou, Chenyu [1 ]
Hou, Bin [1 ]
Zhang, Kai [1 ]
Gao, Shiqi [1 ]
Cao, Fangfang [2 ]
Ji, Yumeng [1 ]
Xie, Enzehua [1 ]
Qiu, Jiawei [1 ]
Qiu, Juntao [1 ]
Yu, Cuntao [1 ]
机构
[1] Chinese Acad Med Sci & Peking Union Med Coll, Natl Ctr Cardiovasc Dis, Natl Clin Res Ctr Cardiovasc Dis, Dept Aort Surg,Fuwai Hosp, 167 North Lishi Rd, Beijing 100037, Peoples R China
[2] Chinese Acad Med Sci & Peking Union Med Coll, Natl Ctr Cardiovasc Dis, Natl Clin Res Ctr Cardiovasc Dis, Adult Surg Intens Care Unit,Fuwai Hosp, Beijing, Peoples R China
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2025年 / 14卷 / 05期
关键词
cerebrospinal fluid drainage; frozen elephant trunk; spinal cord injury; total arch replacement; type A aortic dissection; INTERNATIONAL REGISTRY; PERFUSION-PRESSURE; REPLACEMENT; RISK;
D O I
10.1161/JAHA.124.039427
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Cerebrospinal fluid drainage (CSFD) is commonly used to manage spinal cord injury (SCI) after aortic surgery. However, there is still limited evidence regarding its effectiveness in patients with type A aortic dissection undergoing total arch replacement plus frozen elephant trunk procedure. Methods A total of 1931 patients were retrospectively enrolled between 2010 and 2023. Patients with high-risk postoperative SCI (N=445) were divided into 2 groups: with or without prophylactic CSFD to evaluate the protective effect of prophylactic CSFD. Patients with postoperative SCI (N=119) were divided into 3 groups, without CSFD, therapeutic CSFD, and prophylactic CSFD, and analyzed to compare the treatment effect of different CSFD strategies. Results Prophylactic CSFD significantly reduced the incidence of postoperative SCI in high-risk patients (26.9% versus 17.7%, P=0.029), further supported by matching weights analysis of propensity score and conditional logistic regression. Analyses of the SCI population revealed less severe SCI symptoms in patients with prophylactic CSFD, as assessed by the American Spinal Injury Association Impairment Scale (adjusted P<0.05). Multivariable ordinal logistic regression showed that compared with those without CSFD, prophylactic CSFD (P=0.003) but not therapeutic CSFD (P=0.981) was beneficial to the in-hospital recovery of postoperative SCI. Long-term SCI outcomes did not differ among groups. Conclusions A prominent protective effect on SCI occurrence and recovery after the total arch replacement plus the frozen elephant trunk procedure was observed with prophylactic CSFD use in patients with type A aortic dissection. However, the effectiveness of therapeutic CSFD fell short of significance.
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页数:13
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