Traumatic rupture of the thoracic aorta. A report of 14 cases and a review of the literature.
The major controversy in the surgical repair of acute traumatic rupture of the aorta (TRA) is about the need for distal perfusion and whether or not the benefits of clamping justify the risks involved. To resolve this issue, our experience and 596 cases of acute TRA reported in the English-language literature were reviewed. The operative mortality and incidence of paraplegia among patients who underwent total or partial cardiopulmonary bypass, local temporary aorto-aortic shunting or simple cross-clamping were analysed statistically. The respective mortality rates after the above three procedures were 16,7%, 11,4% and 5,8%, and mortality was significantly increased when distal perfusion techniques were used (P less than 0,01). The incidences of paraplegia among patients who underwent partial left heart bypass, temporary shunting and simple aortic cross-clamping were 2,2%, 2,3% and 5,8% respectively (the differences did not reach statistical significance). Methods of management are discussed. Simple aortic cross-clamping remains the method of choice in uncomplicated cases of acute TRA.
D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D006801:Humans; D008297:Male; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications; D012421:Rupture