Repair of the torn descending thoracic aorta using the centrifugal pump for partial left heart bypass
Ernest E Moore1, Jon M Burch, John B Moore
1Denver Health Medical Center University of Colorado Health Sciences Center, Denver, Colorado, USA. ernest.moore@dhha.org
Insights
Repairing blunt injuries to the descending thoracic aorta using partial left heart bypass significantly reduces paraplegia risk. This technique offers a safer alternative for managing these severe aortic injuries.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Thoracic Surgery
Background:
- Blunt injury to the descending thoracic aorta is a highly lethal condition.
- Traditional "clamp and sew" repair carries a significant risk of paraplegia.
- Partial left heart bypass offers a less morbid alternative to "clamp and sew" repair.
Purpose of the Study:
- To detail the anatomical considerations for repairing blunt descending thoracic aorta injuries.
- To outline the technical steps for surgical repair using partial left heart bypass.
- To present a refined technique for managing descending thoracic aortic injuries.
Main Methods:
- Utilized partial left heart bypass for descending thoracic aorta repair over 25 years.
- Employed preoperative Azā-blockade to mitigate rupture risk.
- Incorporated centrifugal pumps to minimize paraplegia without systemic anticoagulation.
Main Results:
- Detailed description of the management of descending thoracic aorta injuries provided.
- No instances of postoperative paraplegia observed in the study cohort using this technique.
Conclusions:
- Partial left heart bypass is a safe and effective method for repairing blunt descending thoracic aorta injuries.
- This technique virtually eliminates the risk of paraplegia associated with aortic repair.
Objective:
To describe the relevant anatomy and sequential technical maneuvers to repair blunt injuries to the descending thoracic aorta with partial left heart bypass.
Summary Background Data:
Blunt injury to the descending thoracic aorta remains among the most lethal and morbid of anatomic injuries. Of the techniques of repair which have evolved, "clamp and sew" is simple but has an unacceptable risk of paraplegia. In contrast, partial left heart bypass is more complex but virtually eliminates the risk of paraplegia.
Method:
We present a detailed management plan for treating blunt injury to the descending thoracic aorta using partial left heart bypass that has evolved over the past 25 years. Preoperative Azā-blockade to reduce the risk of rupture and use of the centrifugal pump to reduce the incidence of paraplegia without the risk of systemic anticoagulation are essential.
Results:
We present a detailed description of our management of injuries to the descending thoracic aorta. In our experience, no episodes of postoperative paraplegia have occurred with the use of this technique.
Conclusion:
Blunt injury to the descending thoracic aorta can be safely repaired using partial left heart bypass.
