[Results of surgical treatment of acute traumatic aortic rupture]

Between 1967 and 1994 48 patients have been treated at our institution for acute rupture. Two patients died before operation, in two cases the operative attempt had to be abandoned with irreversible cardiopulmonary arrest, and in 44 patients surgical correction could be performed, The rupture was complete in 14 cases and incomplete in 30. In 25 patients surgery consisted of direct suture, in one patient an aortoplasty was performed, and in 18 patients a dacron tube interposition was necessary. In 7 cases the clamp and repair technique was applied, and in 37 cases extracorporeal circulation was installed. The hospital mortality amounted to 18% and was mainly contributable to the concomitant injuries. Two patients presented with paraplegia at admission, both died; postoperative paraplegia occurred in two instances, once after 48 hours. The late results were in the majority of the cases influenced by orthopedic or neurological sequelae, only one patient had to be reoperated for a false aneurysm. Our results and the review of the literature lead to the following conclusions: In spite of an optimized emergency care system, many patients with aortic rupture die before any surgical intervention. The installation of extracorporeal circulation can decrease the incidence of postoperative paraplegia; in our experience the administration of heparin does not increase the risk of bleeding from concomitant injuries. Direct suture represents the correction of choice. The long-term results are excellent.