The effect of adjuvant perfusion techniques on the incidence of paraplegia after repair of traumatic thoracic aortic transections.
OBJECTIVE
To analyze the effect of adjuvant perfusion techniques of the distal aorta on the outcome of traumatic thoracic aortic transections.


METHODS
From 1973 to 2004, 72 patients (mean age, 39 years) with thoracic aortic transections arrived alive at the emergency department. Nineteen patients arrived in extremis and underwent emergency operations, 42 patients were stable and underwent diagnostic evaluation before surgery (4 patients experienced aortic rupture during evaluation), and 11 patients presented more than 24 hours after the accident. Sixteen patients died before aortic repair could be performed. Operative repair was possible in 53 patients (46 stable and 7 in extremis). Interposition graft was performed in 47 patients, and primary repair was performed in 6 patients. Morbidity, mortality, and paraplegia rate were analyzed.


RESULTS
Patients in extremis had a mortality rate of 84% (16 of 19), stable patients had a mortality rate of 11% (4 of 38), patients who experienced rupture during evaluation had a mortality rate of 100% (4 of 4), and patients who underwent delayed operation had a mortality rate of 0% (0 of 11). The paraplegia rate with and without adjuvant distal aortic perfusion techniques was 2% (1 of 41 patients) and 33% (4 of 12 patients), respectively (P=.007). Mortality and paraplegia rates were 4% and 4% for partial bypass (n=24), 42% and 33% for the clamp and sew technique (n=12), 0% and 0% for Gott shunt (n=10), and 29% and 0% for full cardiopulmonary bypass (n=7), respectively.


CONCLUSIONS
Although thoracic aortic transections remain a highly lethal injury, hemodynamically stable patients have a low operative mortality. Spinal cord injury is decreased by the use of adjuvant perfusion techniques that maintain distal aortic perfusion during cross-clamping of the aorta.
Crestanello
Juan A
JA
Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Zehr
Kenton J
KJ
Mullany
Charles J
CJ
Orszulak
Thomas A
TA
Dearani
Joseph A
JA
Puga
Francisco J
FJ
Sundt
Thoralf M
TM
McGregor
Christopher G A
CG
Daly
Richard C
RC
Schaff
Hartzell V
HV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control*; D010477:Perfusion; D011183:Postoperative Complications; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*