Open Repair versus Endovascular Repair of Blunt Traumatic Thoracic Aortic Injuries:Short-and Mid-Term Outcomes

Yuchen Cao＊	Masaaki Koide＊	Yoshifumi Kunii＊
Minori Tateishi＊	Kazumasa Watanabe＊	Satoshi Okugi＊
Risa Shimbori＊

（Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital＊, Hamamatsu, Japan）

Objective:The mainstream strategy for blunt traumatic thoracic aortic injuries（BTAI）has been shifting from conventional open repair（OR）to thoracic endovascular aortic repair（TEVAR). Accordingly, we reviewed the short- and mid-term outcomes following surgical procedures of BTAI, comparing OR with TEVAR. Methods:We retrospectively collected data of consecutive cases of BTAI in a single institution from March 2001 to August 2019. Results:Eighteen cases were identified. Of these, 7 patients（38.9%, mean age 62.0±15.2 years）were treated with OR and 11（61.1%, mean age 61.8±21.3 years）were treated with TEVAR. There was significant reduction in the mean operative duration（OR 444±145 vs TEVAR 65±14min;p＜0.001), the mean intraoperative blood loss（OR 2,787±1,578 vs TEVAR 210±376ml;p＜0.001), the volume of blood transfusions（OR 5,042±2,219 vs TEVAR 929±751ml;p＜0.001), and the mean dose of heparin infusion（OR 20.3±4.1 vs TEVAR 7.9±8.5ml;p＜0.01). Postoperative 30-day mortality of OR and TEVAR were 28.6 and 0%（p＝0.14), respectively. There was no endoleak, 1 case of paraparesis, and 1 case of bilateral cerebellar infarction in the TEVAR group. There was no significant difference in the length of stay in the intensive care unit, the duration of hospital stay, the rate of home discharge, or the mid-term mortality and re-intervention rate（average follow-up period of 42.0±56.9 months). Conclusions:Compared with OR, TEVAR took less operative time with less bleeding, and required less blood transfusions and heparin. The short- and mid-term outcomes following TEVAR for BTAI was favorable and TEVAR appears to be applicable as a first-line treatment for BTAI.

 

Jpn. J. Cardiovasc. Surg. 50:225-230（2021）

Keywords：blunt traumatic aortic injury;open repair;TEVAR;short- and mid-term outcome