Mechanical circulatory support decreases neurologic complications in the treatment of traumatic injuries of the thoracic aorta

R. S. Higgins, J. A. Sanchez, L. DeGuidis, M. L. Dewar, K. L. Franco, G. S. Kopf, J. A. Elefteriades, G. L. Hammond and J. C. Baldwin
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn.

The surgical treatment of traumatic injuries of the thoracic aorta is controversial because a number of technical approaches have been recommended. Despite the technique employed, spinal cord ischemia continues to be a persistent problem. Nineteen patients with confirmed aortic injuries secondary to blunt trauma were treated at the Yale-New Haven (Conn) Medical Center from 1984 to 1991. The patients were analyzed in two groups: group 1 (n = 10) underwent repair using mechanical circulatory support and group 2 (n = 9) underwent repair without mechanical circulatory support. Sixteen patients survived. Three patients died of complications of multiple trauma. The groups were comparable with respect to aortic cross-clamp time, preoperative systolic blood pressure, and Injury Severity Score. Three patients in the nonmechanical support group developed neurologic complications (P less than .05). No patient in the mechanical support group had a neurologic complication. We believe that mechanical circulatory support reduces the incidence of neurologic complications following traumatic injuries of the thoracic aorta and should be used whenever clinically feasible.

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