Repair of traumatic aortic rupture: a 25-year experience

A J Razzouk, S R Gundry, N Wang, M J del Rio, D Varnell, L L Bailey
Archives of Surgery 2000, 135 (8): 913-8; discussion 919

BACKGROUND: Surgical management of traumatic aortic rupture (TAR) is controversial, specifically whether distal aortic perfusion modifies the outcome.

HYPOTHESIS: The outcome of patients who undergo repair of TAR is not dependent on the technique of repair.

DESIGN: Retrospective review.

SETTING: Tertiary care teaching hospital, level I regional trauma center.

PATIENTS: One hundred fifteen victims (aged 5-81 years) of blunt chest trauma with aortic tear, presenting between January 1, 1974, and June 30, 1999.

METHODS: Medical records were reviewed for prehospital and emergency department data, operative findings, and outcome. Statistical comparison was made using a paired 2-tailed t test.

INTERVENTION: Surgical repair of TAR with (group 1) or without (group 2) distal aortic perfusion.

RESULTS: Thirty-two patients in group 1 had TAR repair using active bypass (n = 18) or Gott shunt (n = 14). The clamp-and-sew technique was used in 83 patients (group 2). Primary repair was possible in 14 patients (44%) in group 1 and 69 patients (83%) in group 2. The average aortic cross-clamp time was 48 minutes for group 1 (range, 25-113 minutes) and 20 minutes for group 2 (range, 5-40 minutes) (P<.03). There was no significant difference in hospital mortality (6 [18.7%] of 32 vs 15 [18.1%] of 83) or the incidence of paraplegia (2 [6%] of 32 vs 5 [6%] of 83) between groups 1 and 2. During the last 15 years, 78 patients (73 in group 2) had repair of TAR with an operative mortality rate of 19.2%.

CONCLUSIONS: Acute TAR remains a highly lethal injury with no change in prognosis during the last 2(1/2) decades. Repair of TAR using simple aortic cross-clamping alone is feasible in the majority of patients without increased mortality or spinal cord injury.

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