One-year results of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial)

Ali Khoynezhad, Carlos E Donayre, Ali Azizzadeh, Rodney White
Journal of Thoracic and Cardiovascular Surgery 2015, 149 (1): 155-61.e4

OBJECTIVE: One-year outcomes of the RESCUE trial (endovascular aortic repair using Valiant Captivia for blunt thoracic aortic injury) are reported.

METHODS: RESCUE is a prospective, nonrandomized, multicenter trial. Fifty patients with blunt thoracic aortic injury were enrolled between April 2010 and January 2012. One-year outcomes included secondary procedures, device-, procedure-, and/or aorta-related adverse events, and all-cause mortality.

RESULTS: Mean patient age was 40.7 ± 17.4 years; 76% of patients were male. Fifty-two thoracic stent grafts were implanted within a median of 1 day of injury. Seventy percent (35 of 50) of aortic injuries were grade III or higher, including 1 free rupture. The mean Injury Severity Score was 37.6 ± 14.3. Vascular access, device delivery, and deployment were successful in all patients. The left subclavian artery was completely covered in 40% (20 of 50) and partially covered in 18% of patients (9 of 50). There were no strokes or spinal cord injuries. Median procedure time was 90.5 minutes; median hospital stay was 11 days. All-cause mortality within 1 year was 12%. There were no conversions to open repair. Four patients (8%) had subclavian artery revascularization; 1 preoperatively; 3 others postoperatively on days 8, 36, and 103. There were no device-related adverse events. During follow-up, 1 patient (2%) had aortic-related and 9 patients (18%) had procedure-related adverse events.

CONCLUSIONS: TEVAR has favorable early midterm outcomes in the treatment of blunt thoracic aortic injury, and remains the treatment modality of choice. Longevity of the stent grafts in this young patient population has yet to be established.


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