Simplified perfusion strategy for removing retroperitoneal tumors with extensive cavoatrial involvement Jose L. Navia, MD, Nicolas A. Brozzi, MD, Edward.

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Presentation transcript:

Simplified perfusion strategy for removing retroperitoneal tumors with extensive cavoatrial involvement Jose L. Navia, MD, Nicolas A. Brozzi, MD, Edward R. Nowicki, MD, MS, Eugene H. Blackstone, MD, Venkatesh Krishnamurthi, MD, Martin G. Sinkewich, CCP, Jeevanantham Rajeswaran, MSc, Gregory Pattakos, MD, MS, Bruce W. Lytle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 5, Pages 1014-1021 (May 2012) DOI: 10.1016/j.jtcvs.2011.05.009 Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Time trends of cardiopulmonary bypass (CPB) versus hypothermic circulatory arrest (HCA) for inferior vena cava tumor operations. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1014-1021DOI: (10.1016/j.jtcvs.2011.05.009) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Surgical exposure. Adequate exposure of retroperitoneal tumor and caval tumor–thrombus requires a median sternotomy to expose the right atrium (A) and a tranverse laparotomy (chevron incision) with mobilization of the parietocholic fascia to access the retroperitoneal tumor and inferior vena cava (B). The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1014-1021DOI: (10.1016/j.jtcvs.2011.05.009) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Perfusion technique. Both perfusion strategies use the same cannulation procedures: 2 venous cannulas (A) and 1 aortic cannula and arterial filter (B). For beating-heart cardiopulmonary bypass, 2 additional pump suckers (C) are used to create a bloodless surgical field. A blood-salvage system (D) is also used for blood conservation. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1014-1021DOI: (10.1016/j.jtcvs.2011.05.009) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Freedom from cancer recurrence after operation stratified by perfusion strategy. Each symbol represents a death, vertical lines 68% confidence limits, and numbers in parentheses patients remaining at risk. Solid line is parametric estimate enclosed within 68% confidence bands. For pM1 patients, recurrence was defined as a new site of metastasis. CPB, Resection using continuous cardiopulmonary bypass and a beating heart; HCA, resection using hypothermic circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1014-1021DOI: (10.1016/j.jtcvs.2011.05.009) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Survival after operation stratified by perfusion strategy. Format is as in Figure 4. CPB, Resection using continuous cardiopulmonary bypass and a beating heart; HCA, resection using hypothermic circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 1014-1021DOI: (10.1016/j.jtcvs.2011.05.009) Copyright © 2012 The American Association for Thoracic Surgery Terms and Conditions