Summary
From 1970 to 1985, 49 patients were operated for traumatic aortic rupture (TAR) in
2 university hospitals. Protection of distal ischemia was performed 31 times with
a left heart bypass (LHB), 5 times with a heparin coated shunt and, 13 times using
simple aortic cross-clamping combined with pharmacological vasodilatation. Total mortality
was 17 out of 49, 5 during and 12 after the operation, 2 of them being directly related
to systemic heparinization during LHB. In the LHB and shunt groups there was one postoperative
paraplegia out of 35 patients, while 4 from the 13 patients operated without a shunt
developed paraplegia. If risk factors such as long cross-clamping time, hypotension,
extensive laceration of the inner curvature of the aorta, or cross-clamping of the
aortic arch at a high level are anticipated, LHB or the shunt technique must be considered
to avoid paraplegia. A repair without a shunting procedure should be limited to those
cases in which the individual surgeon believes that he can do the operation within
30 minutes aortic cross-clamping time.
Key words
Traumatic thoracic aortic rupture - Spinal cord injury - Paraplegia
