Partial left heart bypass for thoracic aorta repair. Survival without paraplegia
R. A. Read, E. E. Moore, F. A. Moore and J. B. Haenel
Department of Surgery, Denver General Hospital, CO 80204-4507.
OBJECTIVE: Emergency repair of the torn descending thoracic aorta has been
associated with an almost 15% incidence of paraplegia. The literature to
date suggests that the incidence of paraplegia is not influenced by
mechanical adjuncts to enhance distal aortic perfusion during
cross-clamping and therefore, "clamp and sew" has been considered an
acceptable technique. The purpose of the present study was to review our
experience with repair of descending thoracic aortas using partial left
heart bypass and to compare this favorable initial experience with the
available data on the use of the heparinless centrifugal pump. DESIGN: A
retrospective review of the routine use of partial left heart bypass in 16
consecutive patients with descending thoracic aorta disruptions. Results
were compared with similar reports in the recent literature on trauma.
SETTING: A level 1 trauma facility in the Denver, Colo, metropolitan area.
PATIENTS: All patients with multisystem blunt trauma with a mean injury
severity score of 36. INTERVENTION: Repair of the descending thoracic aorta
disruption using partial left heart bypass with a heparinless centrifugal
pump. MAIN OUTCOME MEASURES: Primary outcome measures were survival and
paraplegia; other monitored variables included proximal and distal aortic
pressure, flow rates, and oxygen transport. RESULTS: Among the 14 survivors
(88%) there were no cases of paraplegia, and intraoperative hemodynamics
and oxygen transport were well maintained with partial left heart bypass.
This experience is added to the available reported data on the use of the
centrifugal pump. In these additional 42 patients, the mortality rate was
7%, with no incidence of paraplegia. CONCLUSIONS: This collective
experience failed to disclose a single case of paraplegia when partial left
heart bypass was employed for repair of descending thoracic aorta.
Moreover, the use of partial left heart bypass in this cohort of critically
injured patients is associated with survival and perioperative morbidity
rates comparable with the best recent reports of emergency thoracic aortic
repair.
