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Ann Thorac Surg 1999;67:959-964
© 1999 The Society of Thoracic Surgeons
a Division of Thoracic & Cardiovascular Surgery, Department of Surgery, Maryland Institute for Emergency Medical Services System, Baltimore, Maryland, USA
Address reprint requests to Dr Attar, University of Maryland Hospital, 22 South Greene St, Baltimore, MD 21201
e-mail: sattar{at}surgeryl.umaryland.edu
Presented at the Forty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 12–14, 1998.
Background. Traumatic aortic rupture is highly lethal, and its surgical treatment is complicated by a high rate of paraplegia.
Methods. The charts of 263 patients with traumatic aortic rupture from vehicular accidents treated between 1971 and 1998 were reviewed. Patients were grouped according to four periods: group 1, 1971 to 1975, (n = 31); group 2, 1976 to 1985, (n = 83); group 3, 1986 to 1994, (n = 82); and group 4, 1994 to 1998 (n = 67). Seventy-one patients died of exsanguination before definitive care. One hundred-ninety two patients had surgical repair with the following techniques: clamp and sew, 6 in group 1, 22 in group 2, 54 in group 3, none in group 4; shunt, 23 in group 1, 39 in group 2, 2 in group 3; cardiopulmonary bypass, 2 in group 1, 1 in group 3. Forty-three patients had partial bypass with the centrifugal pump and heparin-coated circuits in group 4.
Results. Operative mortality was 6 of 31 (19%) in group 1, 22 of 61 (36%) in group 2, 15 of 57 (26%) in group 3, and 7 of 43 (16%) in group 4. There was one case of paraplegia in group 1 (4%), ten in group 2 (18%), 11 in group 3 (26%), and none in group 4. This difference of paraplegia between the groups was significant (p < 0.002). Significant factors for paraplegia were intraoperative hypotension (p < 0.000002), cross-clamp time longer than 30 minutes (p < 0.008), pump versus no pump (p < 0.008), and younger age group (28 ± 11 versus 39 ± 17 years) (p < 0.03).
Conclusions. There were no statistically significant improvements in mortality rate over the four periods, although, the mortality rate was lowest in the last period when partial bypass with the centrifugal pump was used exclusively. Further, the use of the centrifugal pump with heparin-coated circuits, with femoral vein cannulation into the right atrium and distal aortic perfusion, reduced paraplegia significantly.
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