European Journal of Cardio-Thoracic Surgery, Vol 6, 431-436, Copyright © 1992 by European Association for Cardio-thoracic Surgery
Acute traumatic isthmic aortic rupture. Long-term results in 49 patients
R Soyer, JP Bessou, F Bouchart, A Tabley, D Mouton-Schleifer, J Arrignon and M Redonnet
Department of Thoracic, Charles Nicolle Hospital, Rouen, France.
Forty-nine patients who sustained acute traumatic rupture of the aorta at
the level of the isthmus were treated in our hospital between 1976 and
1990. Four patients died before surgery and 45 patients were operated upon
using a pump oxygenator partial bypass in all but 2 cases (1 clamp and sew
and 1 shunt). The tear was circumferential in 33 and partial in 12 cases.
Direct suture was used in the 12 partial and in 21 of the circumferential
tears. A dacron tube was used in 12 patients. Hospital mortality was 3
resulting from brain damage, prolonged shock before surgery and necrosis of
the colon 4 weeks after operation. No paraplegia was observed. There were 2
cases of neurological disturbance (2 spinal cord dysfunction 5 and 8 days,
respectively, after surgery). These complications were transient. Among the
42 survivors, 1 was lost to follow-up. The clinical aortic status of the
remaining 41 was excellent. Aortic reconstitution as assessed by digital
aortic angiography was excellent in the 33 cases examined with 2 exceptions
(graft stenosis, false aneurysm). Our experience and review of a large
series indicate: the use of a partial bypass with pump oxygenator decreases
the probability of medullary ischemia, but the risk of spinal cord ischemia
is not eliminated. When intra-abdominal lesions are life- threatening,
laparotomy must preceed thoracotomy. Clinical results assessed in long-term
survivors are excellent, especially after direct repair.
