1. AL Estrera, MD, D Gochnour, MD, CC Miller III, PhD, A Azizzadeh, MD, S Coogan, MD,J Holcomb, MD, H Safi, MD Progress in the Treatment of Blunt Thoracic Aortic Injury: 12-year Single Institution Experience Aortic Surgery Symposium 2010 New York, NY April, 2010 Department of Cardiothoracic and Vascular Surgery The University of Texas Medical School at Houston Memorial Hermann Heart & Vascular Institute

2. Purpose  Recent advancements in the diagnosis and management of blunt thoracic aortic injury (BTAI) have improved outcomes following operative repair.  With consideration of these advancements, we analyzed our Level 1 trauma experience with BTAI.

3. Methods 255 Blunt Thoracic Aortic Injury Jan. 1997 – March 2009 Median age: 39 (13-91) 71% 29%

4. Management Extremis Stable ABC’s EC Thoracotomy Resuscitate Operating Room or Evaluate Radiographic

5. Presentation Acute Delayed Selective Management Surgery Endovascular Repair

6. Delayed Selective Rx  Severe Head Injury  Infection  Burns  Sepsis  Contaminated wound  Multi-system Trauma

9. Results Total=141 Open (Clamp) N=30 Open (DAP) N=79 Open (CPB) N=6 TEVAR N=26 Paraplegia 3 (10%)0 (0%) Stroke 1 (3%)0 (0%) 1 (3%) Mortality 8 (3%)12 (15%)2 (33%)0 (0%) *(p<0.002)

10. Operative Mortality TAI

11. Overall Mortality TAI- All Patients

12.  Although thoracic aortic injury still accounts for significant mortality during blunt trauma, patients reaching specialized trauma centers can achieve good results with thoracic aortic repair.  Improved early outcomes have been observed with delayed selective management and thoracic endovascular repair.  Long-term results of TEVAR, however, need further study. Conclusions