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• W4245810298 abstract "We appreciate Verdant’s comments regarding our recent work, “Open versus endovascular repair for patients with acute traumatic rupture of the thoracic aorta”1Canaud L. Alric P. Branchereau P. Joyeux F. Hireche K. Berthet J.P. et al.Open versus endovascular repair for patients with acute traumatic rupture of the thoracic aorta.J Thorac Cardiovasc Surg. 2011; 142: 1032-1037Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar; however, we dispute his assertion that we claimed that open repair should be abandoned. Our experience did demonstrate that endovascular repair is associated with both a lower rate of morbidity and a lower mortality. Our results are concordant with the results of the prospective multicenter study of the American Association for the Surgery of Trauma,2Demetriades D. Velmahos G.C. Scalea T.M. Jurkovich G.J. Karmy-Jones R. Teixeira P.G. et al.Operative repair or endovascular stent–graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study.J Trauma. 2008; 64: 561-571Crossref PubMed Scopus (335) Google Scholar which concluded that endovascular repair is associated with significantly lower mortality and fewer blood transfusions. The results of our study thus have prompted us to consider endovascular repair as the first-line therapy for acute traumatic rupture of the thoracic aorta. For patients in hemodynamically unstable condition, endovascular repair should be considered first. For patients in hemodynamically stable condition, however, we believe that the preoperative morphologic evaluations should aim to assess aortic anatomy and thereby detect possible technical limitations (aortic diameter <20 mm, severe aortic isthmus angulation, short proximal aortic neck <20 mm, conical aorta). In the presence of any of these technical restrictions, open surgical treatment should be considered to avoid major preoperative or postoperative complications related to endovascular repair, such as stent–graft collapse or inadvertent coverage of the supra-aortic trunks. The selection bias reported by Verdant with respect to the number of free ruptures in our study is wrong. Actually, a free rupture was observed in 5 patients in the open repair group and in 4 patients in the endovascular repair group. The conclusion of our other work in the same issue of the Journal, “Surgical conversion after thoracic endovascular aortic repair,”3Canaud L. Alric P. Gandet T. Albat B. Marty-Ané C. Berthet J.P. Surgical conversion after thoracic endovascular aortic repair.J Thorac Cardiovasc Surg. 2011; 142: 1027-1031Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar noted that complications may occur after thoracic endovascular aortic repair, either as a result of device failure or from other adverse events, and we stated that these events may necessitate conversion to open repair. Open conversion can be performed with encouraging results by a team experienced in the management of diseases of the thoracic aorta. With the increasing use of thoracic endovascular aortic repair, more and more patients will be seen with indications for surgical conversion. This article’s conclusion does not appear to us to be in complete contradiction with our study of the repair of traumatic transection of the thoracic aorta. Open versus endovascular repair for acute traumatic thoracic aortic ruptureThe Journal of Thoracic and Cardiovascular SurgeryVol. 143Issue 5PreviewIn the November issue of the Journal, Canaud and colleagues1 wrote to compare 2 methods of acute traumatic aortic rupture repair. Comparison of these techniques is very instructive; however, their decision to abandon the traditional open technique and their recommendation to use endovascular stenting as a first-line approach are discordant with and irrelevant to the results obtained by the authors. Full-Text PDF" @default.
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• W4245810298 title "Reply to the Editor" @default.
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• W4245810298 doi "https://doi.org/10.1016/j.jtcvs.2012.01.059" @default.
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