Mechanical Circulatory Support During Repair of Thoracic Aortic Injuries Improves Morbidity and Prevents Spinal Cord Injury

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Abstract
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 primarily 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 μmol/L [2.9±0.9 mg/dL]) than in patients undergoing repair with MCS (115±18 μmol/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. (Arch Surg. 1994;129:494-498)