16. Traumatic Aortic Rupture: Recent Outcome with Regard to Neurologic Deficit

Safuh Attar, Stephen Downing, Marcello Cardarelli, Joseph McLaughlin

University of Maryland School of Medicine

Baltimore, Md.

TRAUMATIC AORTIC RUPTURE

Recent Outcome with regard to Neurologic Deficit

Purpose: To reduce the high incidence of paraplegia complicating traumatic aortic rupture.

Study: Two hundred two patients with traumatic aortic rupture were treated between 1976 and 1998, of whom 167 patients were treated between 1976 and 1985. The overall mortality was 59.3 percent (99 of 167). 86 patients underwent suture-graft repairs with 53 survivors (66 percent). No significant differences were seen in the incidence of paraplegia when aortic shunts were used (36) compared to 17 patients who were not shunted. Ten patients (19.5 percent) developed paraplegia, when aortic clamping exceeded 30 minutes. Heparin bonded ECC circuit, incorporating a centrifugal pump and membrane oxygenator became available in 1995. Since there circuits obviated the need for heparin, we adopted their use in acute trauma with TAR. Surgery was done through a left thoracotomy, with right atrial descending thoracic aortic cannulae being placed percutaneously. Aortic clamping was done under distal aortic partial ECC bypass at 2-4 1/m. 42 patients with TAR were treated with ECC since April 1995. There were six deaths due to head trauma and ARDS. None of the 36 operative survivors developed paraplegia.

Conclusion: This early experience using the new modality of heparinless ECC holds promise for preventing paraplegia and decreasing morbidity associated with TAR.