Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease

Gabriele Piffaretti, Stefano Bonardelli, Raffaello Bellosta, Giovanni Mariscalco, Chiara Lomazzi, Jip L. Tolenaar, Camilla Zanotti, Cristina Guadrini, Antonio Sarcina, Patrizio Castelli, Santi Trimarchi

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Abstract

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.

Original languageEnglish
Pages (from-to)1435-1442.e1
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number4
DOIs
Publication statusPublished - Oct 1 2014

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Spinal Cord Ischemia
Aortic Diseases
Spinal Cord Injuries
Abdomen
Therapeutics
Odds Ratio
Confidence Intervals
Survival
Multicenter Studies
Thorax

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Piffaretti, G., Bonardelli, S., Bellosta, R., Mariscalco, G., Lomazzi, C., Tolenaar, J. L., ... Trimarchi, S. (2014). Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease. Journal of Thoracic and Cardiovascular Surgery, 148(4), 1435-1442.e1. https://doi.org/10.1016/j.jtcvs.2014.02.062

Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease. / Piffaretti, Gabriele; Bonardelli, Stefano; Bellosta, Raffaello; Mariscalco, Giovanni; Lomazzi, Chiara; Tolenaar, Jip L.; Zanotti, Camilla; Guadrini, Cristina; Sarcina, Antonio; Castelli, Patrizio; Trimarchi, Santi.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 4, 01.10.2014, p. 1435-1442.e1.

Research output: Contribution to journalArticle

Piffaretti, G, Bonardelli, S, Bellosta, R, Mariscalco, G, Lomazzi, C, Tolenaar, JL, Zanotti, C, Guadrini, C, Sarcina, A, Castelli, P & Trimarchi, S 2014, 'Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease', Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 4, pp. 1435-1442.e1. https://doi.org/10.1016/j.jtcvs.2014.02.062
Piffaretti, Gabriele ; Bonardelli, Stefano ; Bellosta, Raffaello ; Mariscalco, Giovanni ; Lomazzi, Chiara ; Tolenaar, Jip L. ; Zanotti, Camilla ; Guadrini, Cristina ; Sarcina, Antonio ; Castelli, Patrizio ; Trimarchi, Santi. / Spinal cord ischemia after simultaneous and sequential treatment of multilevel aortic disease. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 4. pp. 1435-1442.e1.
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AU - Lomazzi, Chiara

AU - Tolenaar, Jip L.

AU - Zanotti, Camilla

AU - Guadrini, Cristina

AU - Sarcina, Antonio

AU - Castelli, Patrizio

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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.

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