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

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.