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J Thorac Cardiovasc Surg 2002;124:684-688
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Cavoatrial tumor thrombus: Single-stage surgical approach with profound hypothermia and circulatory arrest, including a review of the literature

From the Department of Cardiovascular Surgery, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.

Received for publication Dec 10, 2001. Revisions requested Feb 18, 2002; revisions received Feb 22, 2002. Accepted for publication Feb 25, 2002. Address for reprints: Bruno Chiappini, MD, Department of Cardiovascular Surgery, Policlinico S. Orsola-Malpighi, via Massarenti, 9-40138 Bologna, Italy (E-mail: bruno_chiappini{at}hotmail.com).

Background: In recent years, heart surgery has been used more frequently to treat diseases that are not primarily of cardiac origin. This is the case for intracardiac extension of infradiaphragmatic tumors, such as renal cell carcinoma, Wilms tumor, uterine tumors, and adrenal tumors, which require radical surgery associated with cavoatrial thrombectomy.
Methods: From April 1987 to April 2001, 13 patients with an infradiaphragmatic tumor with thrombosis of the vena cava, the right atrium, or both underwent surgical resection with cardiopulmonary bypass, arrested circulation, and profound hypothermia.
Results: The in-hospital mortality was 0%. The postoperative complications were respiratory failure (1 patient) and a redo operation for bleeding (1 patient). After a mean follow-up time of 33.9 months, 8 (61.5%) patients were alive.
Conclusions: The use of extracorporeal circulation and deep circulatory arrest provide an optimal technique for removing the tumor thrombus in a bloodless field, even in the presence of metastatic disease, and has good early and long-term results.

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