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J Thorac Cardiovasc Surg 2007;133:1105-1106
© 2007 The American Association for Thoracic Surgery

Brief Communication

Hemodynamic instability during superior vena cava crossclamping: Predictors, management, and clinical consequences

^a Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
^b Department of Anesthesia, European Institute of Oncology, Milan, Italy
^c School of Medicine, University of Milan, Milan, Italy.

Received for publication October 31, 2006; accepted for publication November 28, 2006.

^_* Address for reprints: Francesco Leo, MD, Thoracic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20100 Milan, Italy. (Email: francesco.leo@ieo.it).

The first 20% of the full text of this article appears below.

Prosthetic replacement of the superior vena cava (SVC) has been shown to be a feasible and safe technique in the surgical treatment of selected mediastinal and lung tumors.^1-3 SVC crossclamping is the most utilized technique for reconstruction of the vessel but it causes intraoperative hypotension that can be severe in some instances. The aim of this study was (1) to evaluate the incidence of hemodynamic instability during SVC crossclamping, (2) to evaluate the clinical impact on the postoperative period, and (3) to search for factors influencing its occurrence.

Clinical Summary

Since January 2002, all hemodynamic data concerning patients who had prosthetic SVC replacement at the Thoracic Surgery Department of the European Institute of Oncology were prospectively recorded during surgery with a dedicated software. Severe hemodynamic instability during SVC crossclamping was defined as any hypotension requiring (1) rapid colloids infusion (500 mL/15 min), (2) additional administration of vasoactive agents, (3) suspension of SVC clamping. Intraoperative fluid administration was managed to obtain a mean systemic pressure >80 mm Hg at SVC crossclamping, reducing the risk of cerebral edema.⁴ Patients received 15 to 25 mL · kg^–1 · h^–1 of crystalloids; if the mean systemic pressure of 80 mm Hg was not reached before SVC . . . [Full Text of this Article]

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