Effects of Timing of Repair on Mortality Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury.

Background: Blunt thoracic aortic injuries (BTAIs) are traditionally treated as emergencies with most fixed within 24 hours of arrival by thoracic endovascular aortic repair (TEVAR) regardless of grade of injury. However, the optimal timing of repair remains debated.

Methods: All patients with Grade 2 and 3 BTAI enrolled in the Aortic Trauma Foundation prospective multicenter registry from 2015 to 2022 were categorized dependent on timing of repair (early repair [ER] < 24 hours, late repair > 24 hours). Chi-square/Fisher's exact tests were used to compare patient/operative factors and logistic regression analysis was performed to identify factors related to 30-day mortality.

Results: Two hundred and twenty two Grade 2 and 3 BTAI treated by TEVAR were analyzed, with 179 in the ER group (81%). There was no difference between the groups regarding Injury Severity Score (ISS), Glasgow Coma Scale, age, or gender. Those in ER were more likely to have a widened mediastinum and a shorter distance from the left subclavian artery to the injury. Thirty-day in-hospital mortality occurred in 14 patients (6%), 2 of which were aortic-related. Thirty-day mortality was associated with a higher baseline incidence of coronary artery disease/peripheral vascular disease/previous cardiac revascularization; lower systolic blood pressure, Glasgow Coma Scale, hemoglobin, platelet count, and blood pH; and higher lactate and ISS on arrival. On multivariate regression analysis, lower hemoglobin, higher ISS, and Grade 3 BTAI were associated with 30-day mortality (P < 0.05), although time to TEVAR was not.

Conclusions: In selected patients, delay in performance of TEVAR for Grade 2 and 3 BTAI may be possible. Further research is necessary to identify other factors predictive of success.