Heparinless partial cardiopulmonary bypass for the repair of aortic trauma

Objective: We hypothesized that partial cardiopulmonary bypass with a hepar in-bonded system would be a technically simple, effective adjunct for reduc ing paraplegia during repair of traumatic aortic rupture. It avoids the ris k of heparin, but, unlike left artial-arterial bypass, it can heat, cool, o xygenate, and rapidly infuse volume if needed. Methods: A retrospective review was conducted of patients admitted for aort ic trauma from July 1994 to December 1999. Bypass consisted of femoral veno us (right atrial) cannulation, a centrifugal pump, and an oxygenator/heater /cooler. Arterial return was to the femoral artery or distal aorta. The ent ire system was heparin-bonded and no systemic heparin was given. Results: Heparin-bonded partial bypass was established in 50 patients (mean age 43 +/- 17 years). Crossclamp time was 32 +/- 11 minutes (range 14-70 m inutes), mean flow 3.0 +/- 0.8 L/min, and bypass time 64 +/- 43 minutes. Du ring repair, 58% of patients received volume through the system (mean 1.1 /- 1.9 L). Core temperature rose slightly (35.9 degreesC +/- 0.7 degreesC t o 36.3 degreesC +/- 0.8 degreesC). Three of the 15 patients who underwent p ercutaneous femoral arterial and venous cannulation concomitant with their angiograms had vessel injury, with one limb loss, and this procedure was di scontinued. Thirty-five patients underwent percutaneous femoral vein and di rect distal aortic cannulation without event. The mortality rate for patien ts supported by bypass was 10%, and all deaths were due to other injuries. There were no new cases of paraplegia and no worsening of intracranial or p ulmonary injuries. Conclusions: Heparin-bonded bypass is technically simple to use and avoids the risk of anticoagulation. Paraplegia was avoided. The ability to correct hypothermia, oxygenate, and rapidly infuse volume may simplify management and improve outcomes.