ACUTE TRAUMATIC RUPTURE OF THE AORTIC ISTHMUS - REPAIR WITH CARDIOPULMONARY BYPASS

In an attempt to prevent paraplegia, a devastating complication common after the repair of traumatic rupture of the aorta, we have used part ial cardiopulmonary bypass. Most of the patients in our series (79.5%) underwent other major surgical procedures immediately before or after the aortic repair. Eight of the 110 patients died before aortic repai r could be performed. The aorta was not repaired in 3, because of othe r injuries. In 9, the repair was done without a shunt or bypass; 4 pat ients died and 2 (22.2%) survived without paraplegia. One of the 2 who underwent repair with a Gott shunt died; the survivor suffered no cor d damage. Of the 88 patients whose repair was carried out under cardio pulmonary bypass, 6 died and 80 (90.9%) survived without paraplegia. N one of the last 39 patients has become paraplegic, as vasodilator trea tment is now discontinued during the cross-clamp period. Serious intra cranial injury was present in 19 patients; in 3 (15.8%) the injury bec ame worse after repair. There was no evidence of new or increased intr aabdominal bleeding during heparinization. Except in the event of pulm onary lacerations, systemic heparin therapy was not associated with ma jor problems.