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The Annals of Thoracic Surgery, Vol 58, 585-593, Copyright © 1994 by The Society of Thoracic Surgeons
UO von Oppell, TT Dunne, MK De Groot and P Zilla
A metaanalysis of articles concerning the surgical management of acute
traumatic rupture of the descending thoracic aorta published in the
English-language literature between 1972 and July 1992 was performed. The
overall mortality of 1,742 patients who arrived at the hospital alive was
32.0%, one-third died before surgical repair was started. Paraplegia was
noted preoperatively in 2.6% of these hospitalized patients, and paraplegia
complicated the surgical repair in 9.9% of 1,492 patients who reached the
operating room in a relatively stable condition. Patients then were
analyzed according to the surgical intervention used. Simple aortic
cross-clamping (n = 443) was associated with a hospital mortality of 16.0%
and incidence of paraplegia of 19.2%, despite lower average mean
cross-clamp times (32 minutes; p < 0.01 versus passive or active methods
of providing distal perfusion). In a subset of 290 patients in whom
individual data were available, the cumulative risk of paraplegia was shown
to increase substantially if the duration of aortic cross-clamping exceeded
30 minutes, but only when distal perfusion was not augmented (p <
0.00001). "Passive" perfusion shunts (n = 424) were associated with a
mortality of 12.3%, and the incidence of paraplegia decreased to 11.1% (p
< 0.001). However, shunts inserted from the apex of the left ventricle
had a contradictory high 26.1% incidence of paraplegia compared with shunts
from the ascending aorta (8.2%; p < 0.02).(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia
Department of Cardiothoracic Surgery, University of Cape Town, South Africa.
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