Spinal Cord Protection for Open Descending Thoracic and Thoracoabdominal Aorta Surgery: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database

Background: Spinal cord injury (SCI) is a devastating complication of open descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA). We evaluated the efficacy of spinal drain placement on spinal injury in DTAA/TAAA repair. Methods: Adult patients (≥18 years) undergoing open DTAA/TAAA repair without aortic root, ascending, or arch involvement were identified from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2017-2023). Patients with preoperative paralysis, postoperative spinal drain placement, or who died in the operating theater were excluded. Primary SCI outcomes were (1) lower extremity paralysis lasting >24 hours, and (2) a composite of paralysis and/or paresis lasting >24 hours. Multivariable logistic regression models with adjustment for patient, intraoperative, and aortic disease factors were derived to evaluate the role of spinal drain placement in DTAA and TAAA repair. Results: The study population included 2724 patients from 224 hospitals who underwent DTAA (n = 813; 61.3% spinal drain) or TAAA (n = 1911; 75.2% spinal drain) repairs. Observed rates of SCI were distinctly higher for TAAA than for DTAA repairs (paralysis: 7.3% vs 1.9%, P < .001; paralysis/paresis: 10.3% vs 3.0%; P < .001). Spinal drain was independently associated with increased paralysis (adjusted odds ratio, 3.63; 95% CI, 1.94-6.80; P < .001) and paralysis/paresis (adjusted odds ratio, 2.51; 95% CI, 1.58-4.00; P < .001) in TAAA repair but not DTAA. Conclusions: An unexpected association was found between spinal drain use and increased SCI. We hypothesize that spinal drain use may indicate higher-risk anatomy as opposed to being a causative factor of SCI.