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J Thorac Cardiovasc Surg 2007;133:592
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Superior vena cava replacement for lung cancer using a heterologous (bovine) prosthesis: Preliminary results

Federico Rea, MD, Giuseppe Marulli, MD, Francesco Sartori, MD

Division of Thoracic Surgery, Departments of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy

To the Editor:

We read with great interest the article by Spaggiari and associates,1 and we congratulate the authors for their original contribution.

In agreement with the authors, we think that the use of a synthetic (polytetrafluoroethylene) prosthesis is burdened by several problems, but we disagree with their statement that the autologous pericardium is not sufficient to create a long enough tube to replace the superior vena cava (SVC) completely or in the majority of its length.

In our experience, we used fresh autologous pericardium to replace the SVC (Figure 1, a) in a small series of patients who had a good short- and long-term outcome. In fact, the autologous pericardium can be easily obtained from the patient and it can be shaped by a technique similar to that reported by Spaggiari’s group. Lung tumor primarily invading the SVC is the best indication for surgery; we exclude from surgery patients with SVC involvement by N2 disease. The primary lung tumor usually infiltrates only the anterolateral and posterolateral walls of the SVC. Therefore, the indication for complete SVC replacement is very limited, because it is often possible to apply a pericardial patch.


Figure 1
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  		Figure 1. a, Complete replacement of SVC with a long tube constructed of autologous pericardium. b, Autologous pericardial patch applied to cover a large vascular defect after partial SVC resection.

 
Usually, a complete replacement of the SVC is considered mandatory for tumor invading more than 50% of the vascular wall. Nevertheless, in some cases in our experience we avoided total SVC replacement by using a large autologous fresh pericardial patch shaped to cover up to two thirds of the SVC circumference (Figure 1, b), without resorting to glutaraldehyde-preserved pericardial patches, as described by other authors.2

In conclusion, on the basis of our experience, we favor the use of autologous material to reduce the potential risks related to the application of heterologous prostheses, even if adequately pretreated.

In most cases, an angioplasty with a well-shaped autologous pericardial patch can be used to cover the vascular defect.1-2Go

References

  1. Spaggiari L, Galetta D, Veronesi G, Leo F, Gasparri R, Petrella F, et al. Superior vena cava replacement for lung cancer using a heterologous (bovine) prosthesis: preliminary results. J Thorac Cardiovasc Surg 2006;131:490-491.[Free Full Text]
  2. D’Andrilli A, Ibrahim M, Venuta F, De Giacomo T, Coloni GF, Rendina EA. Glutaraldehyde preserved autologous pericardium for patch reconstruction of the pulmonary artery and superior vena cava. Ann Thorac Surg 2005;80:357-358.[Abstract/Free Full Text]

Related Article

Reply to the Editor
Domenico Galetta and Lorenzo Spaggiari
J. Thorac. Cardiovasc. Surg. 2007 134: 1601-1602. [Extract] [Full Text] [PDF]



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D. Galetta and L. Spaggiari
Reply to the editor.
J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1601 - 1602.
[Full Text] [PDF]

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