Historical review of blunt injury to the thoracic aorta.

Background Traumatic aortic rupture (TAR) is a pathological entity with a high mortality, both spontaneous and perioperative. Delayed surgical repair has been proposed when associated lesions are stabilized. The aim of this study was to validate MRI for detecting both the presence and type of TAR and to monitor posttraumatic aneurysm and associated lesions. Methods and Results Twenty-four consecutive patients with acute chest trauma and suspected aortic rupture, as suggested by emergency CT or chest radiographs, were subjected to MRI and/or angiography in random order. Such parameters as the presence and type of lesion; presence of periaortic, pericardial, mediastinal, or pleural effusion; and presence of associated lesions were considered in every patient. Follow-up imaging was performed exclusively by MRI every 1 to 2 months. TAR was present in 20 patients. No patient underwent surgery in the acute phase; 14 patients underwent surgery at 6.8±2.7 months; 5 are waiting for surgery; and 1 healed spontaneou...

Delayed Surgery of Traumatic Aortic Rupture Role of Magnetic Resonance Imaging

Durability of Mitral Valve Bioprostheses: A Meta-Analysis of Long-Term Follow-up Studies

La disfuncion protesica es una enfermedad adquirida con significativo riesgo quirurgico inmediato, aunque la historia natural a largo plazo es poco conocida. Entre 1974 y 2006 se realizaron 1.535 recambios mitrales aislados (mortalidad hospitalaria, 5%). Un total de 369 pacientes requirieron una segunda intervencion (mortalidad hospitalaria, 8,1%) y 80, una tercera (59,8 ± 11,4 anos). Las causas de la tercera intervencion fueron deterioro estructural (67,5%), dehiscencia periprotesica (20%) y endocarditis (6,3%). La mortalidad hospitalaria fue 15 (18,8%) pacientes. Tras un seguimiento medio de 17,8 anos, 21 pacientes precisaron nueva intervencion (cuarta intervencion) y la curva actuarial libre de reoperacion fue del 40,1% ± 13,8% a 20 anos. La mortalidad tardia fue del 58,5% (supervivencia a 18 anos, 15,4% ± 5,4%). La indicacion de una reintervencion reiterativa mitral debe evaluarse de forma individualizada, dado el alto riesgo quirurgico asociado.

Reintervenciones múltiples sobre la válvula mitral: 30 años de experiencia

http://www.ejves.com/article/S1078588421007826/pdf

Blunt Traumatic Aortic Injury Management, a French TraumaBase Analytic Cohort.

Acute traumatic rupture of the thoracic aorta (ATRTA) is considered to be an emergency which requires immediate surgery. However surgical mortality is high with an average of 20% in the literature. Twenty-seven patients were observed from 1973 to 1986. Three patients were not operated on (Group I). Twenty patients had immediate surgery (group II) with 60% deaths, 4 patients underwent delayed surgery (Group III) with 25% deaths. Analysis of causes of deaths shows that mortality is mainly due to the severity of associated lesions. Associated lesions were present in 72% of patients who did not survive and in only 37% of the survivors. Associated lesions may be lethal initially (E.G. Brain trauma) or they may be aggravated by the thoracic procedure. Complications from associated lesions may also compromise the outcome of the thoracic procedure. It is well known that the majority of deaths from ATRTA are observed within 24 hours. Immediate repair of the aortic lesion should remain the rule when aortic rupture is isolated or associated with moderate injuries. However, in some cases with severe and multiple associated lesions who survive the initial aortic injury, delayed repair of ATRTA could be considered.

Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment

458 patients with a Carpentier-Edwards porcine bioprosthesis (aortic (Ao): 169, mitral (Mi): 289) operated between January 1975 and December 1981, were studied during the first trimester of 1987. Forty seven patients underwent an associated operation. The total follow-up was 3,001 patient-years with a maximum follow-up of 11.4 years and a mean follow-up of 6.5 years. Only 5.6% of patients were lost to follow-up. The patients were aged between 20 and 80 years. The actuarial 9-year survival rate was 69.2 +/- 6.3% for aortic prostheses and 79.6 +/- 3.9% for mitral prostheses. The principal cause of valve failure, appearing with a considerable frequency after 5 years, was primary tissue degeneration which alone represented 67.8% of the causes of valve failure. The rate of absence of valve failure, for all causes combined, was 77.8 +/- 5.9% for the aortic position and 74.9 +/- 4.9% for the mitral position. The actuarial rate of absence of primary tissue degeneration at 9 years was 79.7 +/- 4.1% for aortic prostheses and 75.2 +/- 4.4% for mitral prostheses. The frequency of tissue degeneration decreased with increasing age, representing 2.9%, 1.9% and 1.5% patient-years respectively for the age-groups: 20 to 39 years, 40 to 59 years and 60 to 80 years. However, this difference was not statistically significant. Tissue degeneration was the principal cause for reoperation (n = 59) with an operative mortality of 7.8%.

[Durability of the Carpentier-Edwards porcine bioprosthesis in aortic or mitral positions. 10 years' results on 458 surgically treated cases].

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Acute traumatic rupture of the thoracic aorta. Role of delayed surgical treatment

[Durability of the Carpentier-Edwards porcine bioprosthesis in aortic or mitral positions. 10 years' results on 458 surgically treated cases].