초록접수 현황
| 19F-089 | 구연 발표 |
The Role of Multidisciplinary Team Approach for Treatment of Traumatic Aortic Injury: A Single Level I Trauma Center Experience
Seunghwan Song¹, Seon Hee Kim², Sang-pil Kim¹, Hyun Min Cho²
¹Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University College of Medicine, Busan, Republic of Korea, ²Department of Trauma and Surgical Critical Care, Pusan National University School of Medicine, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Republic of Korea
Purpose : Treatment of Blunt traumatic aortic injury(BTAI) has evolved with improvement of imaging and emergence of endovascular technique. We report our single-centre, 5-year experience using thoracic endovascular aortic repair (TEVAR) and open repair for BTAI.
Methods : We retrospectively reviewed all patients with BTAI at our institution from 2014 to 2018. Patients were grouped according to treatment modality, ie, open repair, TEVAR, or medical management. Treatment plan was decided according to the patient characteristics and injury severity by multidisciplinary team approach. Outcomes included demographics, management, mortality, hospital stay and complication.
Results : There were 42 patients in the study with 16 (40%) undergoing open repair, 17 (40%) receiving TEVAR, 7 (17.5%) managed medically, and 2(5%) who died during triage. Median age was 49 years (interquartile age [IQR] 38, 57.5 years), with 92.5% males, and median Injury Severity Score (ISS) of 33 (IQR 29, 41). Overall mortality was 7.5%. Median hospital stay was 33 days (IQR 19.5, 58.5), 32(80%) patients discharged to rehabilitation facility. Patients undergoing open repair were significantly younger (43 vs 55 years; p=0.002), had smaller aortic diameter (22.3 mm vs 24.0 mm; p=0.00), discharged to home (4 vs 0 patients; p=0.03) than those undergoing TEVAR. Preoperative debranching for zone II TEVAR was done in two cases. There was no late death and re-intervention related to BTAI during 21 months (IQR 5.26, 32.0) follow-up.
Conclusion : Therapeutic decisions for BTAI patients should be multi-modality and multidisciplinary team efforts. Open repair is also important alternative for young patients or patients with unsuitable aortic anatomy.
Methods : We retrospectively reviewed all patients with BTAI at our institution from 2014 to 2018. Patients were grouped according to treatment modality, ie, open repair, TEVAR, or medical management. Treatment plan was decided according to the patient characteristics and injury severity by multidisciplinary team approach. Outcomes included demographics, management, mortality, hospital stay and complication.
Results : There were 42 patients in the study with 16 (40%) undergoing open repair, 17 (40%) receiving TEVAR, 7 (17.5%) managed medically, and 2(5%) who died during triage. Median age was 49 years (interquartile age [IQR] 38, 57.5 years), with 92.5% males, and median Injury Severity Score (ISS) of 33 (IQR 29, 41). Overall mortality was 7.5%. Median hospital stay was 33 days (IQR 19.5, 58.5), 32(80%) patients discharged to rehabilitation facility. Patients undergoing open repair were significantly younger (43 vs 55 years; p=0.002), had smaller aortic diameter (22.3 mm vs 24.0 mm; p=0.00), discharged to home (4 vs 0 patients; p=0.03) than those undergoing TEVAR. Preoperative debranching for zone II TEVAR was done in two cases. There was no late death and re-intervention related to BTAI during 21 months (IQR 5.26, 32.0) follow-up.
Conclusion : Therapeutic decisions for BTAI patients should be multi-modality and multidisciplinary team efforts. Open repair is also important alternative for young patients or patients with unsuitable aortic anatomy.
첨부파일 : TAI table_edit_01.docx
책임저자: Seunghwan Song
Department of Thoracic and Cardiovascular Surgery,
발표자: Seon Hee Kim, E-mail : ksh810427@naver.com