Acute traumatic disruption of the thoracic aorta: a ten-year experience

During a ten-year period, 44 patients were treated for acute traumatic disruption of the thoracic aorta. Of the 44 patients, 21 had operative repair within 48 hours of injury (Group 1); 14 patients had operative therapy electively delayed for 2 to 79 days (Group 2); 5 had operative therapy electively delayed indefinitely (Group 3); 2 had immediate operative repair when a delayed diagnosis was made at 21 and 56 days, respectively (Group 4); 1 patient died during angiography and 1 refused operation (Group 5). Mortality was as follows: Group 1, 24%; Group 2, 14% Group 3, 0; Group 4, 100%; and Group 5, 100%. All operative deaths occurred in the subgroup of 23 patients in whom left heart bypass was utilized. Immediate operative intervention with a heparinized shunt is preferable as soon as the diagnosis of thoracic aortic disruption has been established, but elective delay of operation in patients with severe concomitant injuries can be achieved safely with beta blockade and antihypertensive therapy.