Splanchnic occlusive disease in connection with spinal cord injuries during DTA / TAAA repair

Splanchnic disease is associated with spinal cord injury in patients undergoing open repair of a descending thoracic aneurysm (DTA) and thoracoabdominal aortic (TAAA) aneurysm, as published in the Journal of Vascular Surgery.

To evaluate the effects of splanchnic disease on spinal cord injury and serious adverse events following these procedures, researchers performed a retrospective review of prospectively collected data from a DTA / TAAA database at the Cardiothoracic Surgery Department at Weill Cornell Medical College in New York.

Patients who underwent DTA / TAAA repair with validated splanchnic disease between 1997 and 2019 were included in the study.

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During the entire study period, 888 patients underwent DTA / TAAA repair. 19 were excluded due to lack of data. The patients were grouped according to the absence or presence of splanchnic occlusive disease (81.9% versus 18%). Patients with splanchnic disease had a higher risk profile, including a decreased left ventricular ejection fraction (45% versus 50%), more common renal dysfunction (38.9% versus 24.6%), and a higher rate of peripheral arterial disease (38.2% versus 50%) 22.8%)) compared to patients without splanchnic occlusive disease.

The etiology of aortic disease was more often attributed to the aortic dissection in the group with splanchnic disease (56.1% versus 43.7%), while the non-dissectioning aneurysm was more likely to be attributed to the aortic dissection in the group without splanchnic disease (56.3 % versus 43.9%).

Patients without splanchnic occlusive disease showed more aneurysms that were located more cranially. In comparison, patients with splanchnic disease showed more caudally loaded aneurysms. This group also showed longer aortic pinch and splanchnic ischemic times (41 vs 19 minutes; 28 vs 24.5 minutes). Splanchnic perfusion was more common in this group.

After the propensity score matching, the researchers had 144 pairs of patients. Matching patients with splanchnic occlusive disease had a longer splanchnic ischemic time and a higher use of splanchnic perfusion (28 min versus 26 min; 67.4% versus 42.4%). This group also had a higher rate of spinal cord injury and serious adverse events (6.9% versus 1.4%; 32.6% versus 18.1%). Subgroup analyzes for TAAA repairs of degrees I to III confirmed increased rates of spinal cord injury and serious adverse events in patients with splanchnic disease (8.1% versus 1.7%; 36.9% versus 20.5%).

Finally, sensitivity analyzes with multivariable regression confirmed that both the spinal cord injury and the extent of the aneurysm were significant predictors of splanchnic occlusive disease (odds ratio 2.48 and 3.80; 95% CI 1.04-5.87 and 1.10, respectively -13.12). Survival in this group was reduced at years 1, 5, and 10.

Study limitations include the inability to validate the diagnosis from radiological or clinical records in 36 patients and a possible lack of generalizability for surgical centers that do not specialize in DTA / TAAA repairs.

“[Splanchnic occlusive disease] is a significant predictor for [spinal cord injury] in patients undergoing open DTA / TAAA repair, ”the researchers concluded. “Investigation of measures to increase tolerance to neural ischemia (e.g. hypothermia) is warranted in such patients.”

reference

Gambardella I., Lau C., Gaudino MFL, et al. Splanchnic occlusive disease predicts a spinal cord injury after open repair of the descending thoracic and thoracic abdominal aneurysms. J Vasc Surg. Published online March 4, 2021. doi: 10.1016 / j.jvs.2021.02.030

This article originally appeared on The Cardiology Advisor