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

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.