Demographic characteristics
A total of 774 patients with TA-AAD were enrolled through the inpatient electronic information system. Among them, 293 were excluded due to their surgical procedures not aligning with the inclusion criteria of the study. This exclusion included 226 cases of partial aortic arch replacements without DHCA, 45 cases of hybrid total aortic arch procedures, and 22 cases of chronic type A aortic arch dissections. Finally, 481 cases of TA-AAD were selected for the study, with a mean age of 47.2 ± 16.4 years (29–75 years). This cohort consisted of 425 male and 56 female patients. Among the patients, 22 had aortic dissection tears originating from the aortic sinus, 174 had tears beginning in the ascending aorta, 247 had dissection tears originating from the aortic arch, and 38 patients had dissection tears that started in the descending aorta and extended retrogradely to the aortic arch.
Notably, 39 patients developed SCI postoperatively, with an incidence rate of 8.1%. Among these, 21 patients were diagnosed with paraplegia, while the remaining 18 had incomplete SCI. The preoperative demographic characteristics of both groups are shown in Table
1. Regarding demographic data and preoperative indicators, the two groups demonstrated no significant statistical differences in such variables as age, body mass index (BMI), time from onset to surgery, preoperative complications, preoperative ultrasound results, levels of preoperative leukocytes and hemoglobin, and the number of involved intercostal vessels. However, notable differences were observed in gender distribution, preoperative platelet counts, preoperative D-dimer levels, and the involvement of the Adamkiewicz artery.
Table 1
Preoperative demographic characteristics of patients with TA-AAD
Demographic information | | | |
Age | 46.9 ± 17.2 | 50.7 ± 17.9 | 0.084 |
Gender (male) | 396 (89.5%) | 29 (74.3%) | 0.009 |
BMI | 24.9 ± 3.2 | 26.7 ± 4.1 | 0.612 |
Onset to surgery time (h) | 45[21,124] | 42[19,140] | 0.194 |
Medical history | | | |
Hypertension | 407 (92.0%) | 36 (92.3%) | 0.795 |
Diabetes | 11 (2.4%) | 2 (5.1%) | 0.645 |
Cerebrovascular disease | 21 (4.7%) | 3 (7.6%) | 0.670 |
Smoking history | 224 (50.6%) | 23 (58.9%) | 0.408 |
COPD | 2 (0.4%) | 0 | > 0.999 |
Preoperative situation | | | |
Lactic acid (mmol/L) | 1.9 ± 0.7 | 2.1 ± 0.9 | 0.091 |
PaO2/FiO2 | 265 ± 82 | 249 ± 76 | 0.163 |
D-dimer (µg/mL) | 1.1[0.4,2.9] | 2.7[0.8,3.4] | 0.004 |
Leukocytes (10^9/L) | 12.7 ± 2.4 | 11.6 ± 3.5 | 0.071 |
Hemoglobin (g/L) | 134 ± 21 | 131 ± 25 | 0.647 |
Platelets (10^9/L) | 179 ± 28 | 144 ± 21 | < 0.001 |
Blood creatinine (µmol/L) | 87.5 ± 29.4 | 90.6 ± 30.4 | 0.117 |
Troponin I | 0.02[0.00,0.06] | 0.02[0.00,0.08] | 0.911 |
Aortic root diameter (mm) | 42.1 ± 8.4 | 42.9 ± 10.2 | 0.379 |
Ascending aorta diameter (mm) | 45.8 ± 7.6 | 46.7 ± 8.1 | 0.317 |
Aortic arch (mm) | 39.7 ± 6.5 | 40.1 ± 7.3 | 0.254 |
Proximal descending aorta (mm) | 29.7 ± 4.8 | 31.4 ± 5.7 | 0.089 |
Left ventricular ejection fraction (%) | 62.5 ± 6.4 | 63.8 ± 5.8 | 0.453 |
Adamkiewicz artery involvement | 89 (20.1%) | 16 (41.0%) | 0.004 |
Intercostal arteries originating from the false lumen | 299 (67.6%) | 22 (70.9%) | 0.153 |
Number of involved intercostal vessels | 3 [0,6] | 4 [0,7] | 0.847 |
The intraoperative conditions of the two groups are presented in Table
2. No statistical difference was noted between the two groups concerning surgery duration, intraoperative CPB duration, aortic cross-clamp time, antegrade selective cerebral perfusion time, visceral ischemia time, and intraoperative nasopharyngeal temperature. However, intraoperative blood loss and CSF pressure were substantially higher in the SCI group compared to the control group.
Table 2
Intraoperative characteristics of patients with TA-AAD
Surgical procedures | | | |
Bentall + TAR-FET | 51 (11.5%) | 7 (17.9%) | 0.120 |
CABG + TAR-FET | 29 (6.5%) | 4 (10.2%) | 0.466 |
Bentall + CABG + TAR-FET | 6 (1.3%) | 1 (2.5%) | 0.477 |
Surgery duration (h) | 8.7 ± 1.9 | 9.2 ± 2.2 | 0.068 |
CPB duration (min) | 174 ± 52 | 180 ± 57 | 0.059 |
Aortic cross-clamp time (min) | 139 ± 46 | 144 ± 57 | 0.228 |
Antegrade selective cerebral perfusion time (min) | 32 ± 7 | 30 ± 5 | 0.410 |
Visceral ischemia time (min) | 21 ± 4.7 | 22 ± 5.4 | 0.314 |
Nasopharyngeal temperature (℃) | 24.7 ± 2.9 | 24.2 ± 4.5 | 0.773 |
Intraoperative blood pressure (MAP, mmHg) | 51 ± 7.3 | 50 ± 6.9 | 0.220 |
Intraoperative blood loss (mL) | 1071 ± 446 | 1453 ± 579 | 0.035 |
Intraoperative CSF pressure (mmHg) | 14.7 ± 5.4 | 19.5 ± 7.6 | 0.015 |
Postoperative conditions of both groups are shown in Table
3, indicating a slightly higher in-hospital mortality rate in the SCI group than the normal group (12.8% vs. 2.9%). Furthermore, postoperative complications, including prolonged stays in the intensive care unit (ICU), the necessity for renal replacement therapy, occurrences of low cardiac output, and gastrointestinal complications, were notably more prevalent in the SCI group relative to the normal group.
Table 3
Postoperative outcomes of patients with TA-AAD
In-hospital death within 30 days | 13 (2.9%) | 5 (12.8%) | 0.007 |
ICU stay (days) | 5 [3,11] | 9 [6.17] | 0.001 |
Postoperative renal replacement therapy | 26 (5.8%) | 11 (28.2%) | < 0.001 |
Re-thoracotomy | 4 (0.9%) | 0 | 0.746 |
Postoperative low cardiac output | 5 (1.1%) | 6 (15.3%) | < 0.001 |
Postoperative gastrointestinal complications | 14 (3.1%) | 5 (12.8%) | 0.011 |
PND (stroke and cerebral hemorrhage) | 21(4.7%) | 5(12.8%) | 0.032 |
AF | 82(18.6%) | 6(15.3%) | 0.577 |
Pneumonia | 22(4.9%) | 4(10.2%) | 0.162 |
Sepsis | 21(4.7%) | 2(5.1%) | 0.915 |
Wound infection | 5(1.1%) | 1(2.5%) | 0.439 |
MOF | 19(4.2%) | 3(7.6%) | 0.330 |
IABP | 0 | 0 | |
ECMO | 5(1.1%) | 1(2.5%) | 0.454 |
In the univariate logistic regression analysis, preoperative, intraoperative, and postoperative factors were evaluated. Subsequently, multivariate logistic regression analysis was conducted on variables with a
P value < 0.1. Based on the backward-stepwise regression method, factors with a
P value ≥ 0.1 were removed from the regression model in each step. After adjusting for confounders, the results are shown in Table
4. The analysis identified preoperative platelet count (odds ratio [OR] = 0.774, 95% confidence interval [CI] 0.416–0.895,
P = 0.007) and D-dimer levels (OR = 2.247, 95% CI 1.756–4.226,
P = 0.016) as independent risk factors for SCI after TA-AAD. Other variables that remained significant in the multivariate logistic regression model included gender (OR = 3.117,
P = 0.004), intraoperative CSF pressure (OR = 1.816,
P = 0.029), and postoperative low cardiac output (OR = 2.149,
P = 0.017).
Table 4
Risk factors in multivariate logistic regression analysis of postoperative paraplegia in patients with TA-AAD
Gender | 3.117 | 1.592–8.063 | 0.004 |
Preoperative platelet count | 0.774 | 0.416–0.895 | 0.007 |
Preoperative D-dimer levels | 2.247 | 1.756–4.226 | 0.016 |
Intraoperative CSF pressure | 1.816 | 1.469–3.274 | 0.029 |
Postoperative low cardiac output | 2.149 | 1.736–5.075 | 0.017 |