Scientific paperTraumatic rupture of the thoracic aorta: third decade of experience
Section snippets
Methods
The medical records at Vancouver General Hospital and St. Paul’s Hospital of 58 patients who had traumatic rupture of the thoracic aorta between 1989 and 1999 were retrospectively reviewed. There were 46 male and 12 female patients. The mean age was 39.9 years, and the range was 17 to 85 years. Of the total population, 53 (91.4%) were victims of motor vehicle accidents. Among these were 3 pedestrians and 5 motorcyclists. Of the remainder, 3 (5.2%) fell from heights and 2 (3.4%) had either a
Results
Of the 58 patients, only 45 (77.6%) had the opportunity for definitive surgical management. The nonsurgical group comprised 13 patients (22.4%). Of the surgical group there were 39 survivors (86.7%) and 6 nonsurvivors (13.3%).
Of the 45 patients who had the opportunity for definitive management, the surgical approach was a standard posterolateral left thoracotomy, with endobronchial anaesthesia in all but 1 patient. This patient was managed by median sternotomy for aortic arch injury, with total
Comments
The third decade of the authors experience of traumatic rupture of the aorta was evaluated to determine the influence of nonheparinized cardiopulmonary bypass on controlling the risk of spinal cord injury complicating surgical management and reducing mortality contributed to by associated injuries. The 20-year experience, 1969 to 1989, was reported in 1991 by Kodali et al [1] and documented the incidence of paraplegia was 3.2% with cardiopulmonary bypass, 29% with simple aortic cross- clamping
Conclusions
The third decade of experience of traumatic rupture of the aorta at the University of British Columbia has demonstrated a major improvement in management with significant reduction of morbidity and mortality. At the end of the second decade of our experience, the use of nonheparinized partial cardiopulmonary bypass using the Medtronic Biomedicus centrifugal vortex pump and Carmeda bioactive surface coating of the extracorporeal circuitry was commenced to provide active distal perfusion for
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