Spinal cord ischemia following operation for traumatic aortic transection

Area of Science:

• Cardiovascular Surgery
• Neurosurgery
• Trauma Surgery

Background:

• Traumatic aortic rupture repair carries a risk of spinal cord ischemia.
• Developing protective techniques is essential to minimize neurological deficits.

Purpose of the Study:

• To evaluate the efficacy of different surgical techniques in preventing spinal cord ischemia during traumatic aortic rupture repair.
• To identify the optimal method for reducing the risk of paraparesis or paraplegia.

Main Methods:

• Surgical repair of traumatic aortic rupture in 41 patients using four distinct methods.
• Group 1: Left-heart pump bypass with heparin.
• Group 2: Heparinized aorta-to-descending aorta or femoral artery shunt.
• Group 3: Heparinized left ventricle-to-aorta or femoral artery shunt.
• Group 4: Aortic cross-clamp only.

Main Results:

• No spinal cord ischemia observed in Group 1 (left-heart bypass) or Group 2 (aorta-to-aorta shunt).
• Four patients in Group 3 (left ventricle shunt) developed paraparesis or paraplegia.
• Group 4 (aortic cross-clamp) patients experienced severe shock; four deaths occurred intraoperatively.
• Left ventricle-to-aorta shunts were ineffective in preventing spinal cord ischemia.

Conclusions:

• Left-heart bypass and aorta-to-aorta shunts are effective in preventing spinal cord ischemia after traumatic aortic rupture repair.
• Left ventricle-to-aorta shunts have demonstrated a failure to protect the spinal cord.
• Left-heart bypass or aorta-to-aorta shunts are the preferred procedures in our experience.