Cavoatrial tumor thrombectomy using cardipulmonary bypass without circulatory arrest

James R. Stewart, John A. Carey, W. Scott McDougal, Walter H. Merrill, Michael Koch, Harvey W. Bender

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)717-722
Number of pages6
JournalAnnals of Thoracic Surgery
Volume51
Issue number5
DOIs
StatePublished - 1991
Externally publishedYes

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Thrombectomy
Neoplasms
Cardiopulmonary Bypass
Hypothermia
Budd-Chiari Syndrome
Venae Cavae
Protamines
Wilms Tumor
Hepatic Encephalopathy
Transitional Cell Carcinoma
Renal Cell Carcinoma
Acute Kidney Injury
Surgical Instruments
Renal Dialysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Cavoatrial tumor thrombectomy using cardipulmonary bypass without circulatory arrest. / Stewart, James R.; Carey, John A.; McDougal, W. Scott; Merrill, Walter H.; Koch, Michael; Bender, Harvey W.

In: Annals of Thoracic Surgery, Vol. 51, No. 5, 1991, p. 717-722.

Research output: Contribution to journalArticle

Stewart, James R. ; Carey, John A. ; McDougal, W. Scott ; Merrill, Walter H. ; Koch, Michael ; Bender, Harvey W. / Cavoatrial tumor thrombectomy using cardipulmonary bypass without circulatory arrest. In: Annals of Thoracic Surgery. 1991 ; Vol. 51, No. 5. pp. 717-722.
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