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The Annals of Thoracic Surgery, Vol 51, 717-721, Copyright © 1991 by The Society of Thoracic Surgeons
JR Stewart, JA Carey, WS McDougal, WH Merrill, MO Koch and HW Bender Jr
Of 29 patients with inferior vena caval tumor thrombus, 14 with
supradiaphragmatic extension were deemed suitable for operation. Patients
(age, 7.5 to 70 years) had renal cell carcinoma (n = 8), Wilms' tumor (n =
2), transitional cell carcinoma (n = 1), and adrenal carcinoma (n = 3).
Seven patients had stage III disease, and 7 patients had stage IV disease.
Two patients (group A) had unresectable disease at exploratory celiotomy, 4
patients (group B) underwent tumor thrombectomy without cardiopulmonary
bypass, and cardiopulmonary bypass was employed in 8 patients (group C).
Three of 8 group C patients had Budd-Chiari syndrome at diagnosis.
Cardiopulmonary bypass with moderate hypothermia, and inferior vena caval
interruption (clip or filter), was employed in all patients. There were no
perioperative deaths. Transient neurological impairment was observed
postoperatively in 2 patients. Coagulopathy developed in 1 patient who had
hepatic encephalopathy and Budd-Chiari syndrome preoperatively and in
another patient in whom protamine could not be administered. No patient had
acute renal failure requiring hemodialysis. Median survival is 41 and 17
months in groups B and C, respectively. Some authors have advocated
profound hypothermia and circulatory arrest in these patients. We find that
satisfactory visualization and excision can be performed with
cardiopulmonary bypass and moderate hypothermia, avoiding potential renal,
hepatic, neurological, and septic complications associated with circulatory
arrest.
ARTICLES
Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest
Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
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