This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Dan M. Meyer Michael A. Wait W. Steves Ring Michael E. Jessen Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Peltz, M. Articles by Jessen, M. E. Search for Related Content PubMed PubMed Citation Articles by Peltz, M. Articles by Jessen, M. E. Related Collections Great vessels Mechanical Circulatory Assistance

Hypothermic circulatory arrest for repair of injuries of the thoracic aorta and great vessels

Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8879, USA

*Corresponding author. Tel.: +1 (214) 645-7721; fax: +1 (214) 645-7701.

E-mail address: michael.jessen{at}utsouthwestern.edu (M.E. Jessen).

Traumatic great vessel injuries are frequently lethal events. Expedient diagnosis and prompt repair by clamping and replacing the affected segment of aorta (often with left-heart bypass) can salvage many patients. Rarely, due to the location of the injury or delayed presentation, standard techniques cannot be used and hypothermic circulatory arrest (HCA) is required for access, exposure and repair. The results of surgical reconstruction of acute and chronic traumatic thoracic vascular injuries under these circumstances are not well described. We reviewed all operations on the great vessels at our institution over a 16-year period that had a traumatic etiology and used HCA. Fourteen cases were identified (10 male, 4 female, age 46±4 years), arising from three acute and eleven remote traumatic events. All repairs were performed with cardiopulmonary bypass (mean CPB time was 155±13 min), deep hypothermia, and an interval of circulatory arrest (mean circulatory arrest interval 31±4 min). One patient died in the perioperative period from a stroke (7% 30-day mortality). Another patient exsanguinated from a recurrent pseudoaneurysm 3 months post-repair. No patient developed paraplegia. HCA can be a useful adjunct in managing complex post-traumatic great vessel injuries. Acute injuries of the ascending aorta and transverse arch usually require this technique, but HCA also offers a safe way to manage repair of the descending thoracic aorta when proximal aortic control is compromised.

Key Words: Hypothermic circulatory arrest; Great vessels; Thoracic aorta; Vascular trauma