Noteworthy in Cardiothoracic Surgery 2025 highlights several of the most influential trials and emerging trends shaping cardiothoracic surgical practice. In structural heart disease, new randomized data have expanded consideration of transcatheter aortic valve replacement to asymptomatic patients while reinforcing the importance of longer-term durability and lifetime valve management in lower-risk populations. In heart transplantation, advances in minimally invasive and robotic techniques, alongside growing international experience with donation after circulatory death, underscore both the promise of innovation and the need for disciplined management of ischemic and preservation times. Endovascular management of complex thoracic aortic disease continues to evolve with broader use of branched devices. In thoracic oncology, practice changing trials support a shift towards perioperative chemotherapy and immunotherapy for resectable esophageal, gastroesophageal junction, and lung cancers, redefining surgical timing, coordination, and multidisciplinary care. Finally, continued adoption of minimally invasive and robotic approaches reflects a broader trend toward reducing surgical morbidity while maintaining oncologic and transplant outcomes.

BACKGROUND While thoracic endovascular aortic repair (TEVAR) of the descending aorta has been widespread for several decades, TEVAR for ascending aortic pathology has not been widely implemented. This technique is a promising alternative to medical therapy when patient-specific circumstances prohibit open repair. METHODS We included patients from 2019 to 2025 who underwent ascending TEVAR repair for any indication at our single institution. We characterize the presentation, operative techniques, post-operative course, and follow-up for each patient. RESULTS From 2019 to 2025, we performed seven ascending aortic TEVARs for four acute type A aortic dissections and three aortic pseudoaneurysms. Technical success was achieved in all patients. Six patients survived to hospital discharge. Among these six, the mean intensive care unit length of stay was 2.83 days. No patients had clinically significant strokes peri-operatively. One patient required an open TEVAR explant and repair about six months after index TEVAR and recovered well from the reintervention. Among all seven patients, 5/7 are alive in follow-up ranging from 6-months to 3-years postoperatively. CONCLUSIONS In our experience, TEVAR is an effective alternative to medical management or palliative care for ascending aortic pathology when open repair is of prohibitive risk.

Objective Chest reentry poses challenges for establishing cardiopulmonary bypass (CPB). This study aims to compare postoperative neurologic outcomes between aortic (AC) and innominate cannulation (IC) in redo aortic surgery. Methods We retrospectively reviewed 201 patients undergoing redo sternotomy for aortic aneurysm repair from 2010-2024. Patients were stratified by cannulation site: AC (N = 119) or IC (N = 34), excluding 48 with other approaches. Demographics, intraoperative variables, and postoperative outcomes were compared. Propensity score matching (PSM), logistic regression and Kaplan-Meier analyses were performed. Results Median age was 62.4 years; 75.8% were male. Before PSM, AC had a lower smoking rate (38.7% vs. 64.7%, P=0.012) but a higher partial/total arch replacement (PAR/TAR) rate (68.9% vs. 23.5%, P<0.001) compared to IC. IC was associated with lower nadir temperature (26.9 vs. 27.5 °C, P=0.044), longer cross-clamp (108.5 vs. 87 min, P<0.001), and more antegrade cerebral perfusion alone (91.2% vs. 29.4%, P<0.001). IC required more intraoperative FFP (6 vs. 4 units, P=0.001). After PSM, cross-clamp time did not differ, but IC had longer circulatory arrest (13 vs 9.4 min, P=0.004) and lower end left cerebral oxygen saturation (67% vs. 70%, P=0.021). Postoperative stroke, encephalopathy/delirium, and mortality were similar.In multivariable regression analysis, cannulation site was not associated with postoperative stroke. Ten-year survival rates were 66.6% for AC and 65.0% for IC (Plog-rank=0.551). Conclusions Aortic and innominate cannulations are safe in redo sternotomy for aortic surgery, with similar neurological and survival outcomes. Surgeons may choose either approach based on preference and patient anatomy.

Females have higher 30-day mortality after coronary artery bypass grafting compared with males. We evaluate the relationship between sex and incomplete revascularization as a risk factor for long-term mortality. We performed a single-center retrospective cohort review of adults undergoing isolated first-time coronary artery bypass grafting. Patients were identified through the Society of Thoracic Surgeons adult cardiac surgery database. Bivariate analysis of preoperative variables and postoperative outcomes was conducted. Univariable and multivariable logistic regression models were used to assess predictors of complete revascularization, and Cox proportional hazards models were fitted to evaluate factors associated with 30-day and long-term mortality. Kaplan-Meier survival analysis with log-rank testing was used to compare long-term survival by sex and completeness of revascularization. 1,422 patients (272 [19.1%] female) were included. 30-day and 90-day mortality was not different between females and males, but complete revascularization was significantly lower in females (64% vs. 71.2%, p = 0.023). Multivariable regression showed that older age, lower ejection fraction and low intraoperative hemoglobin were independently associated with all-cause 90-day and 10-year mortality. Female patients with incomplete revascularization were independently associated with all-cause 10-year mortality (HR 1.80 [95% CI: 1.02; 3.01], p = 0.011). In contrast, male patients with incomplete revascularization were not independently associated with 10-year all-cause mortality (HR 1.24 [95% CI: 0.78;1.80], p = 0.223). In conclusion, female patients were less likely to receive complete revascularization, and incomplete revascularization was an independent predictor of worse long-term mortality in female but not male patients. Prioritizing complete revascularization when clinically feasible may improve long-term CABG outcomes in women.

Background The natural history of penetrating aortic ulcers (PAUs) with high-risk radiologic features after thoracic endovascular aortic repair (TEVAR) remains incompletely characterized. This study assessed aortic remodeling and midterm outcomes after TEVAR for such lesions. Methods We retrospectively reviewed patients undergoing TEVAR for high-risk PAUs between 2016 and 2022. Of 220 TEVAR cases, 12 patients (5.5%) met inclusion criteria with appropriate follow-up. Aortic remodeling was assessed per current societal guidelines. Results The cohort included 8 men (66%) with a median age of 73 years and a median follow-up of 31 months (interquartile range, 12.75-59 months). Most PAUs (58%) were located in zone 3; 33% had multiple ulcers, often with >1 high-risk feature. Pre- and post-TEVAR main PAU + intramural hematoma depth averaged 10.1 ± 4.5 mm and 10.1 ± 8.1 mm, respectively. Aortic diameter increased from 41.3 ± 6.0 mm to 45.3 ± 10.4 mm. Complete thrombosis of the main PAU was observed in 92% of patients. Aortic remodeling was positive in 25% and stable in 58% of cases. No 30-day mortality occurred; however, 3 patients (25%) died of nonaortic causes during follow-up. Two reinterventions (17%) were performed for type 2 endoleak and new PAU formation due to cocaine use. Conclusions TEVAR for PAUs with high-risk features results in complete thrombosis in most cases. Whereas positive aortic remodeling occurred in a subset, most patients experienced stabilization of aortic dimensions during midterm follow-up.

Objective This study aimed to evaluate how different approaches for root and arch management during the first surgery for acute type A aortic dissection impact long-term freedom from reintervention, particularly distal reintervention. Methods This is a retrospective cohort study analyzing 164 patients who underwent acute type A aortic dissection surgery from January 2009 to April 2024. Patients were stratified into root replacement (n = 75) and non-root replacement (n = 89) groups. The root replacement group was further stratified by arch intervention type. Kaplan-Meier analysis and Cox regression models were performed to assess the impact of root and arch interventions on freedom from reinterventions. Results Root replacement significantly reduced the risk of any reintervention (hazard ratio, 0.496, P = .032) and open distal reintervention (hazard ratio, 0.307, P = .037) in univariate analyses, but not in multivariate analysis. Total arch replacement significantly reduced the risk of open distal reintervention (hazard ratio, 0.056, P = .011) in multivariate analysis. Patients undergoing combined root and total arch replacement demonstrated 100% 5-year freedom from open distal reintervention, compared with 82% for combined root and hemiarch replacement and 76% for non-root replacement, although only a trend was observed (plogrank = .060). Conclusions Root and total arch replacements in acute type A aortic dissection demonstrated reduced risk of reinterventions, particularly open reintervention distal to the arch. More aggressive approaches have the potential to reduce the burden and cost of subsequent operations and improve long-term outcomes. However, although root and total arch replacements offer excellent long-term benefits, they are more complex with potentially higher perioperative risks. The decision to pursue more aggressive interventions should be based on a comprehensive patient assessment.

Objective: Percutaneous vacuum-assisted mechanical thrombectomy using venovenous bypass is a potential alternative to open surgery for the removal of intracardiac and intravascular/caval thrombi. We sought to evaluate the unique role and efficacy of this procedure in the treatment of high-risk patients deemed poor candidates for surgical thrombectomy. Methods: Between May 2015 and October 2023, 40 patients underwent vacuum-assisted thrombectomy for intracardiac or caval thrombi using venovenous bypass at our medical center. Patient and case characteristics, procedural details, and postprocedural outcomes were collected retrospectively. All procedures involved a multidisciplinary approach by cardiac surgeons, interventional radiologists, and cardiac anesthesiologists. Cardiac electrophysiologists also participated in the procedures when patients needed concomitant cardiovascular implantable electronic device system extractions. Results: Mean age of patients was 50 ± 16 years. Indications included indwelling catheter thrombus (n = 10; 25%), cardiovascular implantable electronic device infection (n = 12, 30%), tricuspid endocarditis (n = 8, 20%), and bland and tumor thrombus (n = 11, 28%, n = 7, 18%, respectively). Successful removal rate (>70% of thrombus removed) was 85% (n = 34). Interventional adjuncts included cardiovascular implantable electronic device lead extraction (n = 10, 25%) and snaring from contralateral access site (n = 7, 18%). In-hospital and 30-day mortality were 5% (n = 2) and 8% (n = 3), respectively. Complications included postoperative red blood cell transfusion (n = 5, 13%), pulmonary embolism (n = 2, 5%), and recurrent thrombosis (n = 2, 5%). Median total follow-up time was 16 ± 3 months, with either complete resolution or decreased burden of residual thrombus. Conclusions: Vacuum-assisted thrombectomy is a rapid, effective, and safe technique when treating critically ill patients with acute intracardiac and caval thrombi and vegetation. It can be a highly valuable adjunct when treating poor candidates for open cardiovascular surgery.

Objective:The "Head First" graft technique has emerged as a preferred approach for aortic replacement by many surgeons. This study evaluated its performance and safety, focusing on operative efficiency, cerebral protection, and its role in open arch repair outcomes. Methods:We reviewed 150 patients who underwent zone 2 or more extensive arch replacement using the "Head First" approach from August 2020 to March 2025. Perioperative variables were compared between patients with acute type A aortic dissection (n = 40) and elective repair (n = 84). Logistic regression identified risk factors for stroke. Results:Patients' median age was 62 [49-69] years, and 64.7% were male. A total of 44% cases were urgent/emergent; 46.7% of patients underwent redo sternotomy, and 77.3% of patients received the frozen elephant trunk procedure. Nadir temperature was 27.4 °C [26 °C-28 °C]. Overall disabling stroke and 30-day mortality were 10.7% and 16.7%, respectively. Compared with elective patients, patients with acute type A aortic dissection had longer bypass (223.5 vs 156 minutes, P < .001) and circulatory arrest (24 vs 16 minutes, P < .001), and more prolonged intubation (65% vs 26.2%, P < .001) and 30-day mortality (40% vs 6%, P < .001). Disabling stroke rates were not significantly different (17.5% vs 8.3%, P = .219), and 3-year cumulative incidence of unplanned reintervention was similar. Male gender was independently protective against stroke (adjusted odds ratio, 0.34, P = .034). In univariable analysis, diabetes was a risk factor for stroke (odds ratio, 3.84, P = .046), whereas age (odds ratio, 1.03, P = .072) and frozen elephant trunk (odds ratio, 7.29, P = .057) showed borderline associations. Conclusions:The "Head First" approach demonstrated acceptable outcomes in complex arch replacement. It prioritizes cerebral protection, facilitates timely reconstruction with shorter circulatory arrest, and may improve technical feasibility.

We previously demonstrated the impact of ethnicity on aortic surgery, with underrepresentation and greater acuity in minority patients, raising concerns regarding access to care. The Centers for Disease Control and Prevention's social vulnerability index (SVI) measure is increasingly used to quantify patient socioeconomic and demographic factors. This study expands on our prior work by incorporating SVI and ethnicity to analyze patient presentation and outcomes in aortic arch surgery.We utilized a single-institution database of patients who underwent total arch replacement or hemiarch repair between 2009 and 2022. A total of 837 patients were placed into five cohorts based on their self-reported race: African American, Asian, Caucasian, Hispanic, and Other, with further subdivision based on SVI (high social vulnerability, ≥75%, normal social vulnerability < 75%). Additional analyses were performed using SVI alone. We compared patient presentation, operative variables, and outcomes based on the above cohorts.African American and Hispanic patients were underrepresented compared with city demographics. High SVI and minority patients presented at younger ages (p = 0.007) with higher blood pressures (p = 0.002). These groups also had more urgent/emergent presentations (p < 0.001) with aortic dissections (p = 0.006). Operatively, high SVI groups had longer cardiopulmonary bypass (p = 0.018), cross-clamp (p = 0.020), and circulatory arrest times (p = 0.002) but fewer adjunctive procedures (p = 0.018). High SVI patients more often required total arch replacement (p = 0.048) and postoperative mechanical circulatory support (p = 0.025). After discharge, African Americans had more emergency department (ED) visits within a year (p < 0.001), although no significant differences were observed in readmission rates or cardiovascular follow-up.Underrepresented groups face barriers to care, as reflected in disparities in demographics, surgical acuity, and postdischarge ED usage. Analyses-based solely on ethnicity overlooked critical differences between normal and high SVI groups, emphasizing the need for care strategies that are both tailored to high SVI groups and racially sensitive applied across all levels of health care.

Objective Paraplegia from spinal cord ischemia (SCI) is a life-altering complication of aortic surgery. Although various strategies have been employed to enhance spinal cord perfusion, no pharmaceutical agents have been used clinically to mitigate the risk of SCI. Inhibition of calcium/calmodulin-dependent protein kinase II (CaMKII) pathway has shown neuroprotective effects in rodent cerebral ischemia; however, its role in spinal cord ischemia-reperfusion injury has yet to be investigated. This study aims to evaluate the potential of CaMKII inhibition with tatCN19o in preventing SCI in a mouse model. Methods Male C57BL/6 mice (aged 7-9 weeks) were used. Both treatment and control groups underwent aortic cross-clamping to induce SCI. The aorta (distal to left carotid artery) and the left subclavian were clamped for 4 minutes. Sham mice had aortic exposure without clamping. tatCN19o (0.1 mg/kg) or placebo was administered intraperitoneally 10 minutes before and 24 hours after SCI. Sham mice received placebo at the same time points. Postoperative motor function was assessed during the first hour and every 12 hours for 48 hours using the Basso Motor Scale (0-9, from no to full function). Mice not surviving until 48 hours were excluded. Spinal cord histological analysis was performed. A blinded motor neuron cell count of lumbar anterior horn was conducted using 20× imaging by 2 reviewers. Results Based on behavioral scores, sham mice (n = 3) regained full motor function within 30 minutes after surgery. All tatCN19o mice (n = 12) recovered faster with full motor scores by 12 hours postoperatively (9 ± 0 vs 7 ± 0.7; P = .02), compared with controls (n = 11). Motor function declined in both groups after 24 hours. At 48 hours, tatCN19o mice had significantly improved motor function (8.2 ± 0.8 vs 3.1 ± 1.3; P = .004) that did not differ significantly from sham (P = .288). In contrast to sham and tatCN19o-treated mice, the lumbar anterior horn of untreated SCI mice showed minimal surviving motor neurons, with vacuolization and pyknosis, suggesting both necrosis and apoptosis. Motor neuron counts were higher in tatCN19o mice than controls (13.2 ± 1.1 vs 7.2 ± 1.6 cells/1200px diameter area; P = .01). Conclusions Inhibiting CaMKII with tatCN19o significantly preserved lower extremity motor function in a mouse SCI model. As in brain tissues, the CaMKII pathway is critical in spinal cord ischemia-reperfusion injury. Further studies are needed to explore CaMKII signaling in SCI and optimize tatCN19o dosing and timing.

Traditional retrograde cerebral perfusion (RCP) parameters may be suboptimal for washout of debris during hemiarch replacement of the ascending aorta, so we have designed a protocol of increased RCP pressure and flow at moderate hypothermia. We hypothesize that higher RCP pressure is safe in neurological outcomes in cases utilizing circulatory arrest at 28°C in elective hemiarch replacement. A retrospective review of a single-institution prospective database was used to search for all patients with elective hemiarch surgery from 2015 to 2022. Two cohorts were created—patients who received RCP only during circulatory arrest at 28°C and patients who received selective antegrade cerebral perfusion (SACP) during circulatory arrest. Neurological and postoperative outcomes were compared. Arterial blood gas measurements during RCP were taken from the left carotid of 34 patients, which were compared with the arterial blood gas from the bypass circuit to ensure adequate oxygen extraction. Propensity score matching was used to adjust for perioperative indices and patient characteristics. A total of 248 patients were in the SACP cohort and 79 patients in the RCP cohort. The two groups were similar based on patient demographics and relevant comorbidities. The cohorts differed in nadir bladder temperature, circulatory arrest time, and cardiopulmonary bypass time. After propensity matching, nadir bladder temperature, circulatory arrest, and cardiopulmonary bypass times were similar. Neurological postoperative outcomes were similar in the unmatched and matched analysis. The median pressure in the RCP group during circulatory arrest was 40 mm Hg. The median change in oxygen from bypass circuit to the carotids is 398 mm Hg with a mean oxygen extraction of 93.3%. These data demonstrate that a more aggressive approach to RCP beyond traditional constraints at 28°C is safe for short periods of circulatory arrest. Even with the new RCP parameters and after adjusting for standard patient and perioperative characteristics, there is no difference between SACP and RCP in neurological outcomes. Further, adequate oxygen extraction is achieved during RCP.

Background:Aberrant subclavian artery (ASA), though rare, can cause dysphagia lusoria and significantly affect quality of life. Conventional treatment involves open ligation and division of ASA, but a robotic approach is becoming more popular. This study assessed outcomes in patients undergoing robotic ASA division. Methods:We retrospectively reviewed 9 patients with dysphagia who underwent robotic division of ASA between 2021 and 2025. Our standard approach is one-stage robotic ligation and division of the ASA, followed by open subclavian-to-carotid transposition (SCT). Patients undergo continued surveillance for potential thoracic endovascular aortic repair (TEVAR) in the event that Kommerell diverticulum (KD) expands. Patient demographics, presentations, aberrant anatomy, operative details, and outcomes were reviewed. Results:The study cohort had a mean age of 49 years and mean body mass index of 30.5 kg/m2. The main presenting symptoms were dysphagia and dyspnea. An aberrant left subclavian artery with right-sided arch was seen in 5 patients; an aberrant right subclavian artery, in 4. Seven patients had KD. Eight patients underwent concurrent SCT; 1 patient had prior TEVAR and carotid-subclavian bypass for large descending thoracic and Kommerell aneurysms. The mean operative time was 169 minutes, and the mean hospital stay was 2 days. There was no postoperative stroke, bleeding, pneumothorax, chyle leak, or mortality; 1 patient experienced transient Horner syndrome. Five patients reported significant improvement in dysphagia, 1 reported moderate improvement, 1 reported mild improvement, 1 reported no change, and 1 was lost to follow-up. Conclusions:This one-stage hybrid approach-robotic ASA division with open SCT-is safe, with no reported postoperative stroke or mortality, and offers excellent patient satisfaction. It provides a minimally invasive alternative for treating dysphagia lusoria.

BACKGROUND:Transfusion has a persistent low risk of transfusion-transmitted infection and transfusion-associated graft-versus-host disease that may be addressed using pathogen reduction. The Red Cell Pathogen Inactivation (ReCePI) trial tested whether amustaline/glutathione pathogen-reduced red cells are noninferior to conventional transfusions for support of acute surgical blood loss. METHODS:A phase 3, double-blinded, noninferiority trial randomized cardiac or thoracic-aorta surgery patients with increased risk of red cell transfusion to receive pathogen-reduced or conventional red cells during and for 7 days postsurgery. The primary endpoint was the proportion of patients with acute kidney injury (AKI), which is defined as an increase from baseline of greater than or equal to 0.3 mg/dl serum creatinine within 48 h of surgery. Noninferiority was claimed if the upper bound 95% CI of the treatment difference was less than half (50%) of the observed conventional arm incidence. Adverse events and treatment-emergent red cell antibodies were assessed for 28 and 75 days, respectively. RESULTS:A total of 581 subjects were randomized, and 321 (55%) were transfused with study red cells. Transfused subjects in both arms had similar baseline demographics, medical histories, hemoglobin levels, and surgical procedures. Hemoglobin day 3 nadir levels (8.6 g/dl [7.8 to 9.2] in the pathogen-reduced arm; 8.4 g/dl [7.8 to 9.3] in the conventional arm; P = 0.52) were comparable. Incidence of AKI by 48 h was 46 of 157 (29.3%) in the pathogen-reduced arm and 45 of 161 (28.0%) in the conventional arm (treatment difference, 0.7%; 95% CI, -8.9 to 10.4%; noninferiority margin, 14.0%; P = 0.001 for noninferiority). AKI within 7 days by Kidney Disease Improving Global Outcomes staging criteria was not different (59 of 159 [37.1%] in the pathogen-reduced arm; 55 of 162 [34.0%] in the conventional arm; P = 0.53), but stage III was more common in the pathogen-reduced arm (pathogen-reduced arm, 15 of 159 [9.4%]; conventional arm, 7 of 162 [4.3%]; P = 0.075). Of 159 pathogen-reduced red cell recipients, 5 (3.1%) developed specific, low-titer antibodies without evidence of hemolysis. CONCLUSIONS:The incidence of AKI in recipients of pathogen-reduced red cells was noninferior to conventional red cell transfusion. Treatment-emergent antibodies were uncommon and not clinically significant.

OBJECTIVE:Thoracic endovascular aortic repair (TEVAR) and transcatheter aortic valve replacement (TAVR) necessitate large-bore arterial access for stent/valve delivery. With improvement of device delivery technology, percutaneous access has become the standard. This may be associated with fewer complications, although the literature is conflicting. The purpose of this study was to compare the outcomes of open versus percutaneous large-bore arterial access at a single institution. METHODS:A total of 1,018 patients who underwent TEVAR or TAVR between 2006 and 2022 were included. Only groins accessed for delivery sheath were included in the analysis, with sizes ranging from 12 to 28 Fr. Access complications included bleeding (hematoma, perforation, rupture, pseudoaneurysm), infection, seroma, dissection, and distal embolization. RESULTS:Delivery sites were successfully closed using a median of 2 percutaneous closure devices. Larger sheath diameter was associated with conversion to open (20 Fr vs 16 Fr, P = 0.004). There was a significantly higher rate of total complications (35.0% vs 8.6%, P < 0.001), infection, bleeding, seroma, dissection, and distal embolization in open compared with percutaneous cases. Multivariable analysis confirmed a significantly lower rate of complication with the percutaneous approach relative to the open approach (odds ratio = 0.17, P < 0.001). CONCLUSIONS:Percutaneous access is associated with significantly lower rates of total complications, infection, bleeding, dissection, and distal embolization when compared with surgical cutdown. Delivery sheath size was associated with conversion to open arteriotomy closure, but the overall incidence was low. Large-bore arterial access closure can be safely achieved using a percutaneous strategy, resulting in fewer complications than with the open approach.

Background Variabilities in access to care may influence outcomes after acute Type B aortic dissection (TBAD). This systematic review and meta-analysis evaluates gender-based and ethnicity-based differences in outcomes, noting that socioeconomic status data were not available in the included literature. Methods A systematic search of PubMed MEDLINE, Embase and Cochrane library was performed. Studies comparing outcomes in male versus female and Black versus White patients with acute TBAD were included. Statistical analyses evaluated mortality, cardiac events, acute kidney injury (AKI), limb ischemia, respiratory complication, spinal cord complication, stroke, length of hospital stay (LOS), intensive care unit (ICU) length of stay. Results Fourteen studies compared outcomes for male and female patients (54,840 patients). Male patients demonstrated a higher risk of AKI (RR = 1.46, p < 0.01; 95% CI: 1.37, 1.55), spinal cord complications (RR = 1.32, p = 0.01; 95% CI: 1.07, 1.63), and longer ICU stay (MD = 1.00, p < 0.01; 95% CI: 0.40, 1.61) after TBAD compared to female patients. No statistically significant discrepancies were identified between male and female patients for mortality, cardiac events, limb ischemia, respiratory complications, stroke, LOS. Subgroup analysis in patients who underwent only thoracic endovascular aortic repair (TEVAR), found similar significant discrepancies between male and female patients. Three studies compared outcomes for white and black patients (498 patients). Ethnicity analyses were underpowered, and did not demonstrate any statistically significant discrepancies in mortality and stroke, between White and Black patients. No studies examined outcomes by socioeconomic status. Conclusions Male patients experienced significantly higher rates of AKI and spinal cord complications, and prolonged ICU stays, compared to female patients. Data on ethnicity were too limited for definitive conclusions, and no socioeconomic status-stratified outcome data were available. This meta-analysis supports prioritizing gender-specific risk mitigation while underscoring the need for adequately powered studies that report data on ethnicity and socioeconomic status to clarify potential disparities.