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J Thorac Cardiovasc Surg 2006;131:594-600
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta

^a Division of Vascular Surgery, Harborview Medical Center and the University of Washington, Seattle, Wash
^b Division of Cardiothoracic Surgery, Harborview Medical Center and the University of Washington, Seattle, Wash
^c Division of Interventional Radiology, Harborview Medical Center and the University of Washington, Seattle, Wash

Received for publication June 21, 2005; revisions received September 23, 2005; accepted for publication October 20, 2005.

^_* Address for reprints: Riyad Karmy-Jones, MD, Department of Surgery, Box 359796, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104 (Email: karmy{at}u.washington.edu).

BACKGROUND: The management of traumatic aortic rupture has evolved from emergency surgery for all to incorporating nonoperative and endovascular approaches. In addition, the greater emphasis on restraint systems over the past decade might result in lower immediate mortality.

METHODS: We reviewed our contemporary experience with reference to a previous report from the same institution to determine whether there has been improvement in outcome related to these factors.

RESULTS: In 1990, a review of 104 patients admitted to our center over a 15-year period (1975-1990) noted an overall mortality of 65%. Forty-two patients died before they could reach the operating room, including 15 who were declared dead on arrival and 27 who died before reaching the operating room. All patients underwent angiography, followed by immediate operation. The mortality rate of those who reached the operating room was 34%, and paralysis-paraplegia occurred in 26% of survivors. A review of 53 patients admitted between January 1, 2000, and April 2005 documented an overall mortality of 26% and a paralysis rate of 4.5% in operative survivors. Only 3 patients died during initial evaluation, 2 who were in arrest on arrival. Eight patients were managed nonoperatively, and 13 were managed by means of deliberate delay before intervention to improve physiologic status. Finally, 19 patients were managed with endografts.

CONCLUSION: The improved outcome over the decade since the initial experience reflects both a reduced severity of injury attributable to restraint systems and a more flexible approach to the acute management, which can modify the effect of associated injuries.

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