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J Thorac Cardiovasc Surg 2007;134:1369-1371
© 2007 The American Association for Thoracic Surgery

Brief Communication

Use of an apical heart suction device to expose the left pulmonary veins during transsternal pneumonectomy

^a Department of Thoracic Surgery, University of Rome "La Sapienza," Rome, Italy
^b Department of Cardiac Surgery, University of Rome "La Sapienza," Rome, Italy.

Received for publication January 18, 2007; revisions received April 10, 2007; accepted for publication April 20, 2007.

^_* Address for reprints: Federico Venuta, MD, Cattedra di Chirurgia Toracica, Università di Roma "La Sapienza," Policlinico Umberto I, V.le del Policlinico, 00100 Rome, Italy. (Email: sofed@libero.it).

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

Lung cancer operations are usually performed through a standard lateral or posterolateral thoracotomy. However, there are some difficult cases with an extended proximal invasion of the pulmonary vessels (artery and/or veins)¹ or the carina² that may require a median sternotomy approach. This incision allows optimal control of the root of the vessels, the ideal exposure for complex vascular reconstructions, and the institution of cardiopulmonary bypass (CPB) with central cannulation if required. The latter may be indicated either to reconstruct a vessel invaded too proximally by the tumor or to address emergency situations. It could also be required to improve exposure of the posterior aspect of the heart and in particular the left atrium. It helps to decompress the cardiac chambers when the heart cannot be vertically lifted by hand retraction. In these situations, a median and upward retraction of the heart could lead to poor diastolic filling, hypotension, and hemodynamic instability. The use of the bypass machine has been shown . . . [Full Text of this Article]