TRAUMATIC AORTIC TRANSECTIONS - 8-YEAR EXPERIENCE WITH THE CLAMP-SEW TECHNIQUE

Background. Because traumatic aortic transection is associated with hi gh mortality rates, great debate exists about the appropriate operativ e technique for treatment of patients who have acute traumatic aortic transection. Methods. To determine the safety and efficacy of the ''cl amp-sew'' method, we retrospectively reviewed our 8-year experience tr eating 75 patients who had aortic injuries secondary to blunt trauma. Seventy-one of these patients were treated surgically. The clamp-sew m ethod was used in all of these operations. Results. Aortic cross-clamp time averaged 24 minutes (range, 14 to 36 minutes), with 4/71 having times in excess of 30 minutes. One patient (clamp time, 28 minutes) be came paraplegic. Significant associated injuries were seen in 51/75 pa tients (48/71 patients with operation), including intrathoracic (35 pa tients), orthopedic (28 patients), intraabdominal (24 patients), and c entral nervous system (17 patients) damage. No patient died within 24 hours of operation. Overall 30-day mortality was 12% (9/75), with 7/9 having two or more aforementioned associated injuries. Of these 7, 5 h ad central nervous system injuries. Two of 9 died within 30 days witho ut two or more associated injuries: 1 Jehovah's Witness of low hemoglo bin, and 1 patient of sepsis. Conclusions. Although any of several man euvers may be appropriate in managing traumatic aortic injuries, the s imple ''clamp-sew'' technique is a safe and effective method for the t reatment of traumatic aortic transections. (C) 1997 by The Society of Thoracic Surgeons.