The relative merits of the heparin-bonded shunt vs. femerofemoral bypass for aortic arch injury.

Six patients with traumatic aortic arch injuries have been repaired with distal aortic perfusion maintained with femerofemoral bypass (three patients) and the heparin-bonded ascending aorta-to-femoral artery shunt (three patients). The two groups are compared regarding pre- and postoperative changes in blood urea nitrogen, creatinine and platelet counts, as well as required blood replacement, days in the hospital, and rapidity of setting up the technique of distal aortic perfusion. No significant difference in the two techniques was demonstrated regarding the above parameters. Both the heparin-bounded shunt and femoral vein-to-femoral artery bypass with the pump oxygenator provide acceptable spinal cord and renal protection. The two techniques should be equally rapid and safe for the larger institution employing cardiopulmonary bypass procedures on a routine basis. The heparin-bounded shunt, however, may provide a more rapid and reliable means of lower aortic perfusion for the smaller institution with less available means of cardiopulmonary bypass support.