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Management of traumatic aortic rupture: a 30-year experience
Marcelo G Cardarelli1, Joseph S McLaughlin, Stephen W Downing
1Department of Surgery, Division of Cardiac Surgery, University of Maryland Medical System, Baltimore, Maryland 21201, USA. mcard001@umaryland.edu
Annals of Surgery
|October 9, 2002
Summary
Traumatic aortic rupture (TAR) surgery outcomes improved with modern diagnostics. Heparin-less cardiopulmonary bypass significantly reduced paraplegia rates in this 30-year study.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Traumatic aortic rupture (TAR) is a life-threatening injury with high mortality.
- Limited institutional experience and surgeon exposure pose management challenges.
Purpose of the Study:
- To review a 30-year experience with traumatic aortic rupture (TAR).
- To evaluate surgical techniques and their impact on outcomes.
Main Methods:
- 219 patients with TAR underwent surgery between 1971 and 2001.
- Diagnosis evolved to spiral computed tomography (CT) with angiography for equivocal cases.
- Surgical groups included clamp-and-sew, passive shunt, and heparin-less partial cardiopulmonary bypass.
Main Results:
- Mortality rates varied: 21.9% (clamp-and-sew), 35.9% (shunt), and 17.8% (bypass).
- Paraplegia incidence was significantly lower with heparin-less bypass (0%) compared to other methods (23.4% and 17%).
- Prolonged aortic occlusion and lack of lower body bypass support correlated with paraplegia.
Conclusions:
- Spiral CT-based diagnosis and surgical management of TAR are reliable.
- Heparin-less distal cardiopulmonary bypass is a safe and effective technique for TAR.
- This method is associated with a reduced incidence of paraplegia.