Paraplegia After Open Surgical Repair Versus Thoracic Endovascular Aortic Repair for Thoracic Aortic Disease: A Retrospective Analysis of Japanese Administrative Data

J Cardiothorac Vasc Anesth. 2022 Apr;36(4):1021-1028. doi: 10.1053/j.jvca.2021.07.043. Epub 2021 Jul 30.

Abstract

Objectives: To comparatively examine the risk of postoperative paraplegia between open surgical descending aortic repair and thoracic endovascular aortic repair (TEVAR) among patients with thoracic aortic disease.

Design: Retrospective cohort study.

Setting: Acute-care hospitals in Japan.

Participants: A total of 6,202 patients diagnosed with thoracic aortic disease.

Interventions: None.

Measurements and main results: The main outcome of this study was the incidence of postoperative paraplegia. Multiple logistic regression models, using inverse probability of treatment weighting and an instrumental variable (ratio of TEVAR use to open surgical repair and TEVAR uses), showed that the odds ratios of paraplegia for TEVAR (relative to open surgical descending aortic repair) were 0.81 (95% confidence interval: 0.42-1.59; p = 0.55) in the inverse probability of treatment-weighted model and 0.88 (0.42-1.86; p = 0.75) in the instrumental-variable model.

Conclusions: There were no statistical differences in the risk of paraplegia between open surgical repair and TEVAR in patients with thoracic aortic disease. Improved perioperative management for open surgical repair may have contributed to the similarly low incidence of paraplegia in these two surgery types.

Keywords: Diagnosis Procedure Combination; aortic diseases; open surgical aortic repair; paraplegia; thoracic endovascular aortic repair.

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery
  • Aortic Aneurysm, Thoracic* / complications
  • Aortic Aneurysm, Thoracic* / surgery
  • Aortic Diseases* / complications
  • Aortic Diseases* / surgery
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Endovascular Procedures* / adverse effects
  • Humans
  • Japan / epidemiology
  • Paraplegia / epidemiology
  • Paraplegia / etiology
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome