Is distal aortic perfusion in traumatic thoracic aortic injuries necessary to avoid paraplegic postoperative outcomes?

The Journal of Trauma
Bryan A WhitsonSara J Shumway

Abstract

Traumatic thoracic aorta injuries account for nearly 8,000 deaths annually in the United States. Clamp-and-sew techniques can lead to high rates of paraplegia. Use of distal aortic perfusion can lead to heparin-related complications, particularly with associated head trauma. Our objective was to evaluate whether or not an individualized approach to operative management provides acceptable neurologic outcomes. A retrospective review (1991-2004) of patients with a traumatic thoracic aortic injury at a Level I trauma center was performed. A total of 67 patients fit the study criteria. Ninety-one percent of patients had concomitant injuries. Median time from injury to evaluation was 38.0 minutes and from evaluation to operating room (OR) 111.0 minutes. Fifty-three percent of patients died before definitive repair could be undertaken; 29% were in the emergency department and 24% were in the OR. When definitive repair occurred, distal aortic perfusion was used in 81% of cases (75% left heart bypass, 6% cardiopulmonary bypass). The remaining 19% underwent clamp-and-sew technique without heparinization. There were no spinal cord deficits or adverse cerebral events related to repair. If definitive repair was completed, the mortality was...Continue Reading

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Citations

Mar 29, 2011·Cardiovascular and Interventional Radiology·Hervé RousseauJulien Auriol
Oct 27, 2009·Journal of Pediatric Surgery·Nathan D AllisonCharles S Cox
Mar 4, 2014·Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia·Ovunc AkdemirOytun Erbas
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Nov 3, 2010·Journal of Vascular Surgery·Mohammad Hassan MuradRonald M Fairman
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Jul 17, 2009·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Hiroshi TokimuraKazunori Arita

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