Thoracic endovascular aortic repair in pediatric patients: A national analysis, 2018-2022.

PURPOSE: This study investigates pediatric Blunt Thoracic Aortic Injury (BTAI) management and outcomes between Thoracic Endovascular Aortic Repair (TEVAR) and Open Aortic Repair (OAR). We hypothesize that TEVAR yields improved mortality compared to OAR.

METHODS

This retrospective study utilized National Trauma Data Bank (NTDB) data (2018-2022) for patients <21 years with BTAI who underwent TEVAR or OAR. Primary endpoints included mortality, hospital and Intensive Care Unit Length of Stay (ICU LOS), discharge disposition, and unplanned Operating Room (OR) visits. Secondary endpoints included clinical and treatment characteristics. Descriptive and bivariate statistics were performed.

RESULTS

Of 1914 pediatric BTAI patients, 520 (27.2 %) underwent operative management; 476 (91.5 %) underwent TEVAR, 44 (8.5 %) underwent OAR. There were no differences in Injury Severity Score (ISS) or Systolic Blood Pressure (SBP) upon arrival (both p > 0.05). OAR patients were younger (17 years [14-19] vs. 19 [17-20], p < 0.001) with more pancreatic injuries (11.3 % vs. 3.15 %, p = 0.02). TEVAR patients had more rib fractures (47.2 % vs. 22.7 %, p = 0.002). There were no differences in mortality (p = 0.63), hospital or ICU LOS (p = 0.56, p = 0.23), or discharge disposition (p = 0.32), but OAR patients had more unplanned OR visits (11.3 % vs. 4.41 %, p < 0.001).

CONCLUSIONS

TEVAR is increasingly used in pediatric BTAI management, with similar outcomes compared to OAR. OAR patients were younger with more unplanned OR visits. Future research should assess TEVAR's suitability in younger patients and long-term outcomes.

LEVEL OF EVIDENCE: III.