Background. The aim of this study was to point out the results of different
techniques of spinal cord protection in surgically-treated patients with t
raumatic thoracic aorta (TTA).
Methods. A multicentric study was carried out involving 182 patients with T
TA. Four patients died before surgery. Two patients were operated on withou
t any investigation and 2 had no aortic tear at thoracotomy. The remaining
174 patients had aortic isthmus disruption and were included in the study.
The mean age was 32.3 14.29 years with 126 men (72.4%) and 48 women (27.6%)
. Road accidents were causal in 163 patients (93.66%); polytraumatism was f
requent. A standard chest roentgenogram led to a diagnosis which was confir
med with aortography in 94.8% of cases. Surgical repair of visceral lesions
was performed in 52 patients (29.9%) for traumatic spleen, liver, diaphrag
m, mesentery, and gut. These operations were done before or after aortic op
eration in 21.3% and 8.656 of cases, respectively. Thirty-three patients (1
9%) died and 9 (5.2%) had paraplegia. Sixtynine patients had clamp and sew
technique (group 1). Ninety-three patients had different types of extracorp
oreal circulation (group 2), and 12 patients had Gott shunt (group 3). No d
ifference appeared between the 3 groups according to mortality and parapleg
ia. But the sex ratio, age, visceral lesions, craniocerebral lesions, the t
ype of aortic repair, and cross-clamp time were discriminative.
Results. The univariate analysis point out age, crossclamp time, hemothorax
, and anatomical type of aortic injury as the risk factors of death. This w
as confirmed by a multivariable test which retained age, cross-clamp time,
and hemothorax as risk factors. When not diagnosed in time, TTA is serious
and has a bad prognosis. In spite of a high mortality and morbidity, the su
rgical management has improved. Immediate operation and medullar protection
are the stumbling block in this operation.
Conclusions. Operation can be delayed in some cases, but one must take care
of hemodynamic instability. This calls for a repair of the serious associa
ted lesions first, or of a quick performing of a thoracotomy for ruptured a
orta. The question remains, is it better to protect the spinal cord with th
e lower aortic perfusion and avoid the simple cross-clamp? Clinical studies
give few answers to this question, and the best answer has not yet been gi
ven, as we lack prospective studies in this field. (C) 2000 by The Society
of Thoracic Surgeons.