Repair of traumatic aortic rupture - A 25-year experience

Background: Surgical management of traumatic aortic rupture (TAR) is contro versial, specifically whether distal aortic perfusion modifies the outcome. Hypothesis: The outcome of patients who undergo repair of TAR is not depend ent on the technique of repair. Design: Retrospective review. Setting: Tertiary care teaching hospital, level I regional trauma center. Patients: One hundred fifteen victims (aged 5-81 years) of blunt chest trau ma with aortic tear, presenting between January 1, 1974, and June 30, 1999. Methods: Medical records were reviewed for prehospital and emergency depart ment data, operative findings, and outcome. Statistical comparison was made using a paired 2-tailed t test. Intervention: Surgical repair of TAR with (group 1) or without (group 2) di stal aortic perfusion. Results: Thirty-two patients in group 1 had TAR repair using active bypass (n=18) or Gott shunt (n=14). The clamp-and-sew technique was used in 83 pat ients (group 2). Primary repair was possible in 14 patients (44%) in group 1 and 69 patients (83%) in group 2. The average aortic cross-clamp time was 48 minutes for group 1 (range, 25-113 minutes) and 20 minutes for group 2 (range, 5-40 minutes) (P<.03). There was no significant difference in hospi tal mortality (6 [18.7%] of 32 vs 15 [18.1%] of 83) or the incidence of par aplegia (2 [6%] of 32 vs 5 [6%] of 83) between groups 1 and 2. During the l ast 15 years, 78 patients (73 in group 2) had repair of TAR with an operati ve mortality rate of 19.2%. Conclusions: Acute TAR remains a highly lethal injury with no change in pro gnosis during the last 21/2 decades. Repair of TAR using simple aortic cros sclamping alone is feasible in the majority of patients without increased m ortality or spinal cord injury.