Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis

Gaudino, Mario; Khan, Faiza; Rahouma, Mohamed; Naik, Ajita; Hameed, Irbaz; Spadaccio, Cristiano; Robinson, N. Bryce; Ruan, Yijun; Demetres, Michelle; Oakley, Christian T; Gambardella, Ivancarmine; Iannacone, Erin; Lau, Christopher; Girardi, Leonard N.

doi:10.1016/j.jtcvs.2020.04.126

Cited by 54 publications

(61 citation statements)

References 25 publications

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“…Patients started in the procedural stage and were at risk for perioperative mortality, SCI, and severe drain complications that resulted in death. The probabilities for these events were based on published meta‐analyses and long‐term follow‐up studies 2,6–9 . Those who survived the procedure would enter one of three long‐term states: alive, alive with SCI, and death.…”

Section: Methodsmentioning

confidence: 99%

“…The use of drain was associated with 0.3 reductions in the odds ratio (OR) of SCI (95% CI: 0.17–0.54) based on the same meta‐analysis. The estimated probability of a severe CSF drain complication was 5.1% (95% CI: 2.2%–11.1%) in a meta‐analysis of 22,634 patients 8 . Rong et al 2 estimated that the mortality associated with severe CSF drain complications to be 0.9% (95% CI: 0.6%–1.4%) in a meta‐analysis of 4714 patients.…”

Section: Methodsmentioning

confidence: 99%

“…The probabilities for these events were based on published meta-analyses and long-term follow-up studies. 2,[6][7][8][9] Those who survived the procedure would enter one of three long-term states: alive, alive with SCI, and death. To address uncertainty, the model was fully probabilistic in that at each model iteration, all inputs were simultaneously sampled from a distribution based on its' point estimate and accompanying 95% confidence interval (CI).…”

Section: Model Overviewmentioning

confidence: 99%

“…The estimated probability of a severe CSF drain complication was 5.1% (95% CI: 2.2%-11.1%) in a meta-analysis of 22,634 patients. 8 Rong et al 2 estimated that the mortality associated with severe CSF drain complications to be 0.9% (95% CI: 0.6%-1.4%) in a meta-analysis of 4714 patients. A long-term follow-up study of patients undergoing TAAA repair demonstrated a 5-year survival of 51 ± 3% in those without SCI and 25 ± 6% in those with SCI.…”

Section: Model Inputsmentioning

confidence: 99%

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Decision analysis and personalized clinical tool for cerebrospinal fluid drains in thoracoabdominal aortic aneurysms repair

et al. 2020

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Background and Aim: The routine use of cerebrospinal fluid (CSF) drainage in patients undergoing operative repair of thoracoabdominal aneurysms (TAAA) has been associated with decreased rates of spinal cord ischemia. The use of CSF drains is not without consequence, however with complications including subarachnoid hemorrhage, epidural hematoma, meningitis, and, in 1% of cases, death. To date, a decision analysis tool to help clinicians decide when to use and not to use a CSF drain does not exist. In this analysis, we set out to develop a decision analysis tool for CSF drain placement in patients undergoing operative repair of TAAA. Methods: A Markov state-transition cohort model that compared TAAA repair with adjunctive CSF drain insertion to TAAA repair without drain insertion for the outcome of life expectancy was developed in TreeAge 2020. The cycle length was 1 month and the time horizon was 60 months. Results: The use of a CSF drain was associated with improved 5-year life expectancy (3.21 ± 0.10 vs. 3.09 ± 0.11 life-years gained). In the sensitivity analysis that varied the effectiveness of a CSF drain (odds ratio closer to 1 = less effective), the use of a CSF drain resulted in higher life expectancy in almost all scenarios. Conclusions: The routine use of a CSF drain in patients undergoing TAAA repair is safe and effective, with few exceptions. This decision analysis tool can be used by clinicians to develop a personalized approach.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Model Overviewmentioning

confidence: 99%

Section: Model Inputsmentioning

confidence: 99%

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Decision analysis and personalized clinical tool for cerebrospinal fluid drains in thoracoabdominal aortic aneurysms repair

et al. 2020

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“…Cerebrospinal fluid drainage (CSFD), along with other protective adjuncts, have reduced the rate of permanent SCI to 5% to 8%. [1][2][3][4] In this issue of the Journal, Abdelbaky and colleagues 5 present a retrospective review of 100 patients who underwent open DT/TAAA repair with CSFD as a routine adjunct, with excellent outcomes, including a permanent paraplegia rate of 2% and an in-hospital mortality rate of 6%. This success is likely secondary to several factors, including surgical expertise, routine use of other protective adjuncts, and case mix; nearly one-half of the population underwent lower-risk DT rather than TAAA repair, and the proportion of emergent patients was low.…”

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confidence: 99%

Commentary: Cerebrospinal fluid drainage: One component of a successful distal aortic surgery program

et al. 2021

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A Multi‐Bioactive Nanomicelle‐Based “One Stone for Multiple Birds” Strategy for Precision Therapy of Abdominal Aortic Aneurysms

et al. 2022

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AAAs are characterized by the abdominal aortic diameter ≥3 cm or having ≥50% increase in the largest diameter of the abdominal aorta. [3] The estimated prevalence of AAA is 4-8% among people over 65 years old. [3b,4] Most individuals with AAAs are asymptomatic, but rupture of AAA results in mortality as high as 90%. [3a,5] Therefore, AAA is a serious and lethal aortic disease. The natural process of AAA is implicated by the continuous enlargement of the infrarenal aorta, and the turbulent blood flow in the aortic lumen promotes the formation of intraluminal thrombus. [3,6] Once the aneurysm diameter is larger than 5.5 cm, the risk of AAA rupture remarkably increases. [3b] Thus far, surgical intervention, including open surgery and endovascular aneurysm repair (EVAR), remains the only available choice for effective management of AAA. [7] Nevertheless, the surgical intervention of AAA has shown various post-operative complications, such as infection, [8] endoleak, [9] cardiopulmonary events, [10] acute kidney injury [11] and spinal cord injury. [2,12] Moreover, ≈20-30% patients require re-intervention after surgery owing to reperfusion and associated secondary aneurysm rupture, leading to reduced patient compliance as well as increased surgical risk and mortality. [2,3] Besides, surgical treatment is not suitable for Abdominal aortic aneurysm (AAA) remains a lethal aortic disease in the elderly. Currently, no effective drugs can be clinically applied to prevent the development of AAA. Herein, a "one stone for multiple birds" strategy for AAA therapy is reported. As a proof of concept, three bioactive conjugates are designed and synthesized, which can assemble into nanomicelles. Cellularly, these nanomicelles significantly inhibit migration and activation of inflammatory cells as well as protect vascular smooth muscle cells (VSMCs) from induced oxidative stress, calcification and apoptosis, with the best effect for nanomicelles (TPTN) derived from a conjugate defined as TPT. After intravenous delivery, TPTN efficiently accumulates in the aneurysmal tissue of AAA rats, showing notable distribution in neutrophils, macrophages and VSMCs, all relevant to AAA pathogenesis. Whereas three examined nanomicelles effectively delay expansion of AAA in rats, TPTN most potently prevents AAA growth by simultaneously normalizing the pro-inflammatory microenvironment and regulating multiple pathological cells. TPTN is effective even at 0.2 mg kg −1 . Besides, TPTN can function as a bioactive nanoplatform for site-specifically delivering and triggerably releasing anti-aneurysmal drugs, affording synergistic therapeutic effects. Consequently, TPTN is a promising multi-bioactive nanotherapy and bioresponsive targeting delivery nanocarrier for effective therapy of AAA and other inflammatory vascular diseases.

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Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms: A meta-analysis

Cited by 54 publications

References 25 publications

Decision analysis and personalized clinical tool for cerebrospinal fluid drains in thoracoabdominal aortic aneurysms repair

Decision analysis and personalized clinical tool for cerebrospinal fluid drains in thoracoabdominal aortic aneurysms repair

Commentary: Cerebrospinal fluid drainage: One component of a successful distal aortic surgery program

A Multi‐Bioactive Nanomicelle‐Based “One Stone for Multiple Birds” Strategy for Precision Therapy of Abdominal Aortic Aneurysms

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