Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine

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Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine Brian Lima, MD, Edward R. Nowicki, MD, Eugene H. Blackstone, MD, Sarah J. Williams, MS, Eric E. Roselli, MD, Joseph F. Sabik, MD, Bruce W. Lytle, MD, Lars G. Svensson, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 4, Pages 945-952.e1 (April 2012) DOI: 10.1016/j.jtcvs.2012.01.029 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Proportions of patients in whom intrathecal papaverine was used during repair. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Spinal cord injury after descending thoracic aortic (DTA) and thoracoabdominal aneurysm repairs. A, Unadjusted and propensity-matched outcomes of patients treated with (IP) or without (Non-IP) intrathecal papaverine. B, Outcomes stratified by extent of aortic disease for papaverine (IP) group versus no papaverine (Non-IP) group. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Percentages of patients with a neurologic deficit who had any movement through the first 5 postoperative days. Symbols are raw percentages at each time point; solid line and 68% confidence bands are adjusted for repeated measures. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Early postoperative complications after descending and thoracoabdominal aneurysm repair. Patients receiving intrathecal papaverine (IP) had significantly (P < .05) less renal failure necessitating dialysis and decreased hospital stay (LOS) relative to patients with no intrathecal papaverine (Non-IP). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Long-term survival after descending thoracic aortic and thoracoabdominal aortic aneurysm repair. Each symbol represents a death positioned on a vertical axis by the Kaplan-Meier estimator, vertical bars are confidence limits equivalent to ±SE, and numbers in parentheses are patients still alive and traced at 6 months and at 1, 3, 5, and 7 years. Solid lines are parametric survival estimates enclosed within dashed 68% confidence bands equivalent to ±SE. A, Survival after aneurysm repair procedure stratified by papaverine (IP) versus no papaverine (Non-IP) group (n = 330). B, Survival after aneurysm repair stratified by papaverine (IP) versus no papaverine (Non-IP) group among matched patients (n = 136; 68 matched pairs). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Survival after aneurysm repair stratified by permanent neurologic deficit. Format is as in Figure 5. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Mirrored histogram of distribution of propensity scores for papaverine versus no papaverine groups. Shaded area represents matched patient pairs. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Covariable balance description before and after matching between papaverine and no-papaverine groups. NYHA, New York Heart Association functional class; Prev, previous; BMI, body mass index; MI, myocardial infarction; PAD, peripheral arterial disease. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 945-952.e1DOI: (10.1016/j.jtcvs.2012.01.029) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions