OBJECTIVE To describe the relevant anatomy and sequential technical maneuvers to repair blunt injuries to the descending thoracic aorta with partial left heart bypass. BACKGROUND Blunt injury to the descending thoracic aorta remains among the most lethal and morbid of anatomic injuries. Of the techniques of repair which have evolved, "clamp and sew" is simple but has an unacceptable risk of paraplegia. In contrast, partial left heart bypass is more complex but virtually eliminates the risk of paraplegia. METHODS We present a detailed management plan for treating blunt injury to the descending thoracic aorta using partial left heart bypass that has evolved over the past 25 years. Preoperative Azā-blockade to reduce the risk of rupture and use of the centrifugal pump to reduce the incidence of paraplegia without the risk of systemic anticoagulation are essential. RESULTS We present a detailed description of our management of injuries to the descending thoracic aorta. In our experience, no episodes of postoperative paraplegia have occurred with the use of this technique. CONCLUSIONS Blunt injury to the descending thoracic aorta can be safely repaired using partial left heart bypass.