Continuing experience with liver resection and vena cava reconstruction using cardiopulmonary bypass and hypothermic circulatory arrest.
When the suprahepatic vena cava or the hepatic vein confluence with the inferior vena cava (IVC) is obscured by tumor or a clot in the IVC extends above the liver, cross-clamping the IVC during liver or retroperitoneal resection is hazardous. This report describes a 10-year experience with ten patients who had liver (seven) or retroperitoneal (three) resections with vena cava reconstruction using cardiopulmonary bypass and hypothermic circulatory arrest. There were no perioperative deaths. Morbidity consisted of prolonged bile leak (one), pulmonary embolism (one), and stroke (one). Control of the liver was secured in six of seven patients who had a liver resection. There were three significant advantages to this technique. First, the median sternotomy provided superior exposure to the suprahepatic IVC. Second, the bypass technique avoided the risks of hemodynamic instability and prevented air embolism and sudden uncontrolled hemorrhage incurred by resection or IVC cross-clamping. Third, hypothermia provided a method of protection for residual liver function especially in the face of chronic liver disease induced by infection or chemotherapy.
Sener
Stephen F
SF
Division of General Surgery of the Department of Surgery, Evanston Northwestern Healthcare, Illinois, USA.
Winchester
David J
DJ
Votapka
Timothy V
TV
McGuire
Michael S
MS
O'Connor
Brent
B
Szokol
Joseph W
JW
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D006324:Heart Arrest, Induced; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*