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J Thorac Cardiovasc Surg 2005;129:1050-1055
© 2005 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
a Department of Radiology, University Hospital Rangueil, Toulouse, France
b Department of Cardiovascular Surgery, University Hospital Rangueil, Toulouse, France
c Department of Cardiology, University Hospital Rangueil, Toulouse, France
Received for publication October 26, 2004; revisions received December 13, 2004; accepted for publication December 20, 2004. * Address for reprints: H. Rousseau, MD, University Hospital Rangueil, 01 av J Poulhes, 31403 Toulouse, France (E-mail: rousseau.h{at}chu-toulouse.fr).
OBJECTIVE: The study’s objective was to comparatively evaluate surgery and stent-graft repair of acute or subacute traumatic aortic rupture.
METHODS: A total of 76 patients (14–76 years old; mean, 37 years; male/female ratio, 63/11) with a traumatic aortic injury were admitted to our hospital between 1981 and 2003. Six patients died within 1 to 9 days of another associated severe traumatic lesion. The 70 remaining patients were divided according to the type of rupture repair. In group 1, 35 patients were treated surgically: 28 with immediate repair and 7 with delayed repair (average time interval 66 days, 5–257 days). In group 2, 29 patients were treated with stent grafting of the aortic isthmus. In group 3, 6 patients with minor aortic lesions were treated medically with a close follow-up.
RESULTS: In the 28 patients treated surgically in the emergency department, the mortality and paraplegia rates were 21% and 7%, respectively. No death or paraplegia was observed in the group with delayed surgical repair. With stent grafting, complete exclusion of the pseudoaneurysmal sac was observed in all patients. Except for 1 iliac rupture treated during the same procedure, there was no major morbidity or mortality during the mean follow-up of 46 months (13–90 months). No major complication was observed in group 3.
CONCLUSIONS: In stable rupture of the aorta, initial conservative treatment is safe and allows management of the major associated lesions. Stent grafting of the aortic isthmus is a valuable therapeutic alternative to surgical repair, especially in patients considered high risk for conventional thoracotomy.
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