Deep Hypothermia and Low Flow for Surgery for Abdominal or Extraperitoneal Tumors With Cavoatrial Extension Jean-Noel Fabiani, MD, PhD, Maxime Raux,

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Deep Hypothermia and Low Flow for Surgery for Abdominal or Extraperitoneal Tumors With Cavoatrial Extension Jean-Noel Fabiani, MD, PhD, Maxime Raux, MD, Jean-Marc Alsac, MD, PhD, Leonora Du Puymontbrun, MD, Alain Bel, MD, Jérome Jouan, MD, Suzanna Salvi, MD, Julia Pouly, MD, Paul Achouh, MD, PhD The Annals of Thoracic Surgery Volume 95, Issue 6, Pages 2036-2041 (June 2013) DOI: 10.1016/j.athoracsur.2013.03.012 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Longitudinal opening of right atrium and inferior vena cava allowing exposure of the thrombus and the origin of the hepatic veins. The Annals of Thoracic Surgery 2013 95, 2036-2041DOI: (10.1016/j.athoracsur.2013.03.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Extraction of the tumoral thrombus from the hepatic veins and the right heart, and resection of the infrahepatic inferior vena cava (IVC). The Annals of Thoracic Surgery 2013 95, 2036-2041DOI: (10.1016/j.athoracsur.2013.03.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Surgical field after thrombus removal, with verification of the patency of the hepatic veins. The Annals of Thoracic Surgery 2013 95, 2036-2041DOI: (10.1016/j.athoracsur.2013.03.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Atriohepatic confluent reconstruction with direct anastomosis of the hepatic veins in the right atrium, using a pericardium patch. The Annals of Thoracic Surgery 2013 95, 2036-2041DOI: (10.1016/j.athoracsur.2013.03.012) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions