J Thorac Cardiovasc Surg 2006;132:732
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
Riyad Karmy-Jones, MD
Department of Surgery, Harborview Medical Center, Box 359796, 325 Ninth Ave Seattle, WA 98104
(Email: karmy{at}u.washington.edu).
We appreciate the kind comments made by Dr Murala and colleagues, and we agree with the operative technique and indications they describe. They have highlighted an ongoing issue with respect to managing traumatic aortic disruption in a patient who has not finished growing. Not only do late complications of erosion need to be considered, but we wonder whether the stented aorta will be prevented from growing, leading in later life to possible coarcation physiology. Thus as we and others have noted, endovascular approaches to this problem need to be incorporated into an algorithm that includes open repair, medical management, or both. We would argue that endovascular stenting be considered if there are contraindications to operative repair and to medical management (recognizing that different surgeons and centers might vary in what is considered a contraindication). Furthermore, because the vast majority of pediatric patients will be candidates only for cuff extenders or contralateral limbs, these should be used only if they can be applied predominantly on the "straight" portion of the descending aorta (to minimize endoleak) and if the proximal points of endografts are not so close to the left common carotid artery that any subsequent operation would require an anterior arch approach.
Related Article
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Traumatic rupture of the aorta in children—stenting or surgical intervention? A word of caution
- John Santosh Kumar Murala, Andrew Numa, and Peter Grant
J. Thorac. Cardiovasc. Surg. 2006 132: 731-732.
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