Pediatric Aortic Arch Repair: Revolutionary Care for Traumatic Cardiac Injuries
Nicklaus Children’s Hospital has long been at the forefront of advancing pediatric cardiac and cardiovascular surgical care. In the 1960s, we became the first facility in Florida to perform open-heart surgery on pediatric patients. In the mid 1990s, we opened the first pediatric Cardiac Intensive Care Unit in the southeastern United States. Today, we continue to move the needle in pediatric cardiac care, pioneering innovative clinical research and offering advanced, lifesaving procedures.
The renowned physicians at the Nicklaus Children’s Heart Institute use their many years of experience to perform advanced procedures, including complex trauma surgeries, requiring exceptional expertise. One such procedure is aortic arch surgery. Although often performed on adults who develop aortic aneurysms, aortic arch surgery can benefit babies with congenital defects and pediatric trauma patients with post-traumatic aneurysms due to aortic transections.
“This operation is almost always performed on adults,” says Joseph Forbess, MD, Chief of Cardiovascular Surgery at Nicklaus Children’s. “But here at Nicklaus Children’s, we are prepared to handle rare situations.”
A Critical Injury
Dr. Forbess and the multidisciplinary team at Nicklaus Children’s recently performed aortic arch surgery on a young patient who had been in an all-terrain vehicle (ATV) accident.
“The ATV rolled on top of the child, pushing the breastbone from anterior to posterior straight into the aorta, which tore in two but didn’t freely rupture,” Dr. Forbess says. “The child also had a torn esophagus and badly bruised lungs.”
The patient was rushed to a nearby hospital, where surgeons attached an artificial heart and lung machine. The child’s lungs and esophagus began to heal, but surgery was still needed for the torn aorta. Because the family lived in South Florida and the referring surgeons were familiar with Nicklaus Children’s program, the patient was transferred to here for care.
Lifesaving, Multidisciplinary Care
The young patient entered the care of our multidisciplinary team to ensure the injuries received appropriate treatment.
“When trauma occurs, it impacts a wide swath of the body,” Dr. Forbess says. “This patient’s injuries included the heart, lungs and esophagus, which meant it was important for general surgeons and cardiac surgeons to come up with a plan together.”
The first step was ensuring the esophagus had healed properly, and imaging studies showed it had. The cardiology team also kept a close eye on the patient’s blood pressure. The general pediatric surgeons then transferred the patient to the cardiovascular surgery team for the aortic arch repair.
Many young patients with an aortic transection can be treated with a minimally invasive transcatheter solution. However, this was not an option for the patient because the disruption was located directly between the blood vessels going up the right and left sides of the neck.
Dr. Forbess repaired the aorta using a technique that involved implantation of a graft, allowing room for the aorta to grow.
The surgeons were very pleased with the results of the surgery and the patient’s overall recovery.
Aortic arch repair is one of many surgical solutions offered at the Nicklaus Children’s Heart Institute. To learn how we can help your patient, email our physician liaison today.