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J Thorac Cardiovasc Surg 2007;134:897-901
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Emergency repair of traumatic aortic rupture: Endovascular versus conventional open repair

^a Department of Cardiothoracic Surgery, Bristol Heart Institute at the Bristol Royal Infirmary, Bristol, United Kingdom
^b Department of Cardiology, Bristol Heart Institute at the Bristol Royal Infirmary, Bristol, United Kingdom.

Received for publication March 26, 2007; revisions received June 5, 2007; accepted for publication June 15, 2007.

^_* Address for reprints: Alan J. Bryan, DM, FRCS (CTh), Consultant Cardiac Surgeon, Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin St, Bristol BS2 8HN, United Kingdom. (Email: Alan.Bryan{at}ubht.swest.nhs.uk).

Objective: Our objective was to compare early results of endovascular stenting for traumatic aortic rupture with conventional open repair.

Methods: We conducted a retrospective review of consecutive cases of traumatic aortic rupture in a single institution from July 2000 to July 2006.

Results: Fifteen cases were identified. The mean injury severity score was 43 ± 10. Fourteen patients had the procedure within 24 hours of admission to the hospital. Seven patients underwent endovascular stenting and 8 underwent open repair. For endovascular stenting, there were no failed procedures, no periprocedural complications, and no periprocedural deaths. In 6 patients, there was no evidence of endoleak, stent migration, or late pseudoaneurysm formation. One patient required a second stent 2 years later to treat a stenosis in the original stent. For open repair, cardiopulmonary bypass was used in 7 of the 8 patients. Lower limb paraplegia developed postoperatively in 1 patient and another patient died of head injuries. There was a significant reduction in the mean duration of the procedure (2.2 ± 0.90 vs 5 ± 3.2 hours; P = 0.04), the mean intraoperative blood loss (311 ± 20 vs 953 ± 20 mL; P = .02), the mean number of units of blood and blood products used (0.43 ± 1.1 vs 3 ± 3 units; P = .026), and the mean dose of heparin required (5000 ± 1700 vs 24,000 ± 7500 IU; P = .001) in the endovascular stenting group. There was no difference in duration of ventilation, intensive treatment unit, or hospital stay.

Conclusions: Endovascular stenting is technically feasible and applicable to a range of cardiac patients. It takes less time than open repair, requires less heparin and blood products, and therefore simplifies management of other injuries. In hemodynamically stable patients, endovascular stenting is the treatment of choice for traumatic aortic rupture.