Mechanical circulatory support during repair of thoracic aortic injuries improves morbidity and prevents spinal cord injury
A. D. Forbes and D. G. Ashbaugh
Division of Thoracic Surgery, Harborview Medical Center, University of Washington, Seattle.
OBJECTIVE: Evaluation of mechanical circulatory support (MCS) vs simple
cross clamping (CC) during repair of traumatic descending thoracic aortic
transections. DESIGN: A retrospective analysis of all patients admitted
with blunt traumatic injury to the descending thoracic aorta from August
1988 through March 1993. Patients were pseudorandomized to simple CC vs MCS
according to the on-call surgeons' preferences. SETTING: A level 1 trauma
center in Seattle, Wash. PATIENTS: Forty-two patients were admitted. Thirty
(71%) survived, 21 of whom underwent repair with MCS and nine underwent
repair with CC only. INTERVENTION: Prompt aortic repair was performed
either primary or by replacement with a Dacron graft. MAIN OUTCOME
MEASURES: Operative survivors were examined for new neurologic deficits,
renal function, pulmonary failure, gastrointestinal tract complications,
sepsis, and length of hospitalization. Causes of death in all patients were
determined. RESULTS: Twelve patients died, seven before surgery and five
during surgery. In survivors, new neurologic deficits occurred in four
(44%) of nine patients undergoing repair with CC and in none of the
patients undergoing repair with MCS (P = .0005). Mean (+/- SEM)
postoperative serum creatinine levels were higher in patients undergoing
repair with CC (256 +/- 80 mumol/L [2.9 +/- 0.9 mg/dL]) than in patients
undergoing repair with MCS (115 +/- 18 mumol/L [1.3 +/- 0.2 mg/dL]) (P <
.05). Patients undergoing repair with CC had longer hospitalization and
higher incidence of pulmonary, gastrointestinal, and septic complications,
all of which approached statistical significance. CONCLUSIONS: Mechanical
extracorporeal perfusion of the distal aorta during occlusion of the
thoracic aorta for traumatic descending thoracic aortic injuries may
prevent spinal cord ischemia and reduce postoperative organ dysfunction.
The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta.
J. Thorac. Cardiovasc. Surg. 2006;131:594-600.
Operative Technique, Paraplegia, and Mortality After Blunt Traumatic Aortic Injury
Hochheiser et al.
Arch Surg 2002;137:434-438.
ABSTRACT
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Bypass Techniques for Descending Thoracic Aortic Surgery
Hessel
SEMIN CARDIOTHORAC VASC ANESTH 2001;5:293-320.
ABSTRACT
Choice of venous cannulation for bypass during repair of traumatic rupture of the aorta
Karmy-Jones et al.
Ann. Thorac. Surg. 2001;71:39-41.
ABSTRACT
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Heparinless partial cardiopulmonary bypass for the repair of aortic trauma
Downing et al.
J. Thorac. Cardiovasc. Surg. 2000;120:1104-1111.
ABSTRACT
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Surgical outcome of traumatic rupture of the thoracic aorta
Tatou et al.
Ann. Thorac. Surg. 2000;69:70-73.
ABSTRACT
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Traumatic aortic rupture: diagnosis and management
Gammie et al.
Ann. Thorac. Surg. 1998;66:1295-1300.
ABSTRACT
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