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The effect of adjuvant perfusion techniques on the incidence of paraplegia after repair of traumatic thoracic aortic transections.

Abstract：

OBJECTIVE:To analyze the effect of adjuvant perfusion techniques of the distal aorta on the outcome of traumatic thoracic aortic transections. PATIENTS AND 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.

journal_name

Mayo Clin Proc

journal_title

Mayo Clinic proceedings

authors

Crestanello JA,Zehr KJ,Mullany CJ,Orszulak TA,Dearani JA,Puga FJ,Sundt TM 3rd,McGregor CG,Daly RC,Schaff HV

doi

10.4065/81.5.625

subject

Has Abstract

pub_date

2006-05-01 00:00:00

pages

625-30

issue

eissn

0025-6196

issn

1942-5546

pii

S0025-6196(11)61707-2

journal_volume

pub_type

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The effect of adjuvant perfusion techniques on the incidence of paraplegia after repair of traumatic thoracic aortic transections.