Traumatic tears of the thoracic aorta: improved results using the Bio-Medicus pump.
Traumatic disruption of the descending thoracic aorta is a relatively rare but dramatic injury. Controversy remains regarding the use of shunts during operative repair. Discouraged by our results using the "no shunt" technique, we adopted the recently reported technique using the Bio-Medicus pump for left atrium-femoral artery bypass without heparin sodium. At Charlotte Memorial Hospital and Medical Center, 39 patients were treated for tears of the descending thoracic aorta between January 1979 and October 1988. Eight patients died before repair could be completed. Four patients underwent repair using femorofemoral bypass with 1 death and no instances of paraplegia. Fifteen patients had repair using the no-shunt technique with 4 deaths and three instances of paraplegia. Since January 1986, 12 patients have been treated using the Bio-Medicus heparinless pump with no deaths and no instances of paraplegia. We present our experience to confirm the reports of others regarding the efficacy of this technique. We believe it reduces the morbidity and mortality associated with this serious injury and aids in the hemodynamic management of the patient during aortic clamping.
Hess
P J
PJ
Department of Thoracic and Cardiovascular Surgery, Charlotte Memorial Hospital, North Carolina.
Howe
H R
HR
Robicsek
F
F
Daugherty
H K
HK
Cook
J W
JW
Selle
J G
JG
Stiegel
R M
RM
D000328:Adult; D001013:Aorta, Thoracic / Q000293:injuries*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D001243:Assisted Circulation; D003250:Constriction; D005260:Female; D005263:Femoral Artery; D006325:Heart Atria; D006353:Heart-Assist Devices; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation; D008297:Male; D010264:Paraplegia / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D014950:Wounds, Penetrating / Q000601:surgery*