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Eur J Cardiothorac Surg 2004;25:1032-1038
© 2004 Elsevier Science NL
a Clinic for Cardiovascular Surgery at Zurich University Hospital, Zurich, Switzerland
b Department of Trauma Surgery at Zurich University Hospital, Zurich, Switzerland
c Department of Radiology at Zurich University Hospital, Zurich, Switzerland
Received 3 November 2003; received in revised form 7 March 2004; accepted 8 March 2004.
* Corresponding author. Address: 89 Longwood Ave Apt 6, Brookline, MA 02446, USA. Tel.: +1-617-320-0018
e-mail: smelnitchouk{at}partners.org
Objective: To report mid-term results of stent-graft (SG) implantation in acute thoracic aortic rupture as alternative to conventional open surgery with its associated high morbidity and mortality rates. Methods: Out of a series of 69 patients undergoing thoracic aortic SG implantation since 1998, 24 (mean age 57±19 years, range 20–85-years-old) patients were treated on an emergency basis for hemorrhage control. The indication for SG placement was acute traumatic aortic rupture in 15 patients, type B dissection with contained rupture in 3 patients, penetrating aortic ulcer with periaortic hematoma in 3 patients, and thoracic aortic aneurysm rupture in 3 patients. Preoperative assessment was done by computed tomography (CT) scanning and echography. Patients were treated in the angiography suite by implantation of Excluder (n=18), Talent (n=4), Corvita (n=1), and Vanguard (n=1) self-expanding grafts. Local anesthesia was the most frequently used anaesthesiologic technique. Results: Technical success rate of SG deployment was 100%. The early postoperative mortality was 12.5% (3 of 24). One patient suffered temporary paraplegia (4%). There was no intervention-related mortality during the mean follow-up of 34.1 months. Two secondary endoleaks were successfully treated with additional SG placement at 2 and 12 months postoperative, respectively. Conclusions: Emergency SG repair to control hemorrhage in patients with an acute thoracic aortic rupture is a less-invasive attractive and rational treatment option, especially if associated lesions or co-morbidity may interfere with the surgical outcome. Long-term follow-up results will be helpful to clarify procedure durability bounded by material failure and postoperative aneurysm or aortic wall remodelling.
Key Words: Thoracic aorta • Acute rupture • Endovascular • Stent-graft
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