Treatment of acute and chronic traumatic rupture of the descending thoracic aorta

Abstract

Techniques have undergone much change since the first successful repair of an acute traumatic rupture of the descending thoracic aorta was performed by Klassen at our hospital in 1959. It is interesting that we are returning to the techniques which worked so well in that case. Using this approach, which involves virtual elimination of the use of cardiopuimonary bypass, and evaluating each patient individually for the use of a shunt, we have reduced our mortality rate from 61% (8 deaths among 13 patients) during the period 1959--1974, to 6% (1 death among 17 patients) in the last 5 years. We believe that these data confirm the validity of this approach in the management of acute blunt descending thoracic aortic rupture. Prevention of spinal cord ischemia has become the primary concern for continuing clinical and laboratory investigation.

Traumatic Aortic Rupture

“…Since acute rupture of the thoracic aorta resulting from non-penetrating chest trauma is a lethal injury, immediate surgical repair is advocated by nearly every cardiothoracic surgeon (4,10). However, multiple lesions of other organs are commonly associated with aortic lesions (1).…”

The use of the Biomedicus centrifugal pump in combination with a separate reservoir with integrated heat exchanger in aneurysms of the thoracic aorta

“…Current limitations of the LLBS are that: (1) it is an open reservoir (the use of a level detector is strongly recommended); (2) there is no commercially available separate reservoir with integrated heat exchanger (the venous reservoir was removed from the Excell membrane oxygenator); and (3) considering the minimal heparinization of the patient, it is essential to prevent the patient's blood flowing into the integrated reservoir at all times, so that clotting in the reservoir is avoided. There is a clear need for the development of a reservoir with a heat exchanger specifically designed for this therapy, and also for investigation into the improvement of the safety in the clinical application of this system.…”

“…The use of a heparinized shunt, total cardiopulmonary bypass (CPB), leftleft bypass with only a centrifugal pump or simple cross-clamping with graft interposition have been proposed by various authors. [1][2][3][4][5][6][7][8][9][10][11][12][13] No matter which technique is applied, these operations are often accompanied by excessive blood loss and a requirement for rapid transfusion, resulting in substantial haemodynamic fluctuations. Hypothermia may become a problem in these patients because most blood Figure 1 Console with disposable components warmers are unable to warm blood adequately (>35° C),14-16 at high flow rates (>100 cc/min).…”

Intraluminal shunt for the thoracic aorta: Spinal cord and visceral blood flow in acute studies

“…Operative management remains controversial, as passive external shunting and pump-bypass methods have not completely prevented these complications, and there are multiple potential problems related to extracorporeal circulation. Therefore many surgeons have abandoned currently used shunt/bypass methods and have espoused the no-shunt ("clamp and sew") technique [1][2][3][4][5][6][7][8][9]. Because paraplegia, renal failure, and various degrees of injury to other tissues are the result of ischemia and reperfusion injury, provision of distal flow during aortic reconstruction would be highly efficacious.…”