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Ann Thorac Surg 1992;53:233-239
© 1992 The Society of Thoracic Surgeons
Surgical Cardiovascular Unit, Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
* Address reprint requests to Dr Hilgenberg, Department of Thoracic Surgery, Massachusetts General Hospital, 32 Fruit St, Boston, MA 02114.
We managed 51 patients with thoracic aortic injuries caused by blunt trauma between 1977 and 1990. Fortynine injuries were located in the upper descending aorta and one each in the ascending aorta and anatic arch. Three patients arrived moribund and underwent thoracotomy for resuscitation, and all died. The diagnosis was confirmed by aortography in 48. One patient died of aortic rupture, 1 died of hypoxemia, and 1 refused operation and died. Forty-four patients had aortic repair, 42 with graft insertion. Gott shunts were placed in 23 with 3 cases of paraplegia (13%). Simple cross-clamping was used in 19 with 1 case of paraplegia (5.2%). We found statistically significant differences between the cross-clamp times of patients without paraplegia compared with those in whom paraplegia developed in both the shunt and no-shunt groups. Logistic regression analysis showed that the only factor significantly associated with paraplegia was cross-clamp time. There were two postoperative deaths (4.4%). Seven patients had medical therapy initially and aortic repair was delayed to allow other injuries to stabilize. Before aortic repair, 18 patients had intraarterial pressure monitoring and 34 received β-blockers or antihypertensive drugs. We conclude that aortic repair with graft insertion is usually successful in nonmoribund patients, simple crossclamping is associated with a relatively low risk of paraplegia, the incidence of paraplegia is directly associated with the duration of cross-clamp time, and selected patients can be managed medically while awaiting aortic repair.
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