Bridging circuit for the resection of retroperitoneal sarcoma involving the aorta and the IVC- veno-venous to veno-arterial perfusion.
A 50-year-old female underwent surgery for removal of a massive retroperitoneal sarcoma (RPS) involving the right hepatic lobe and the inferior vena cava (IVC), abdominal aorta, right lung, right hemi-diaphragm and pericardium. Resection of the RPS necessitated cross-clamping of the abdominal aorta, IVC and the hepatic artery. Cross-clamp time cannot be predicted prior to tumour resection and vascular re-construction. To prevent complications of prolonged cross-clamp time and distal hypo-perfusion, circulatory support was sought to facilitate the procedure. A perfusion circuit was designed to accommodate an easy and immediate redirection of blood flow from venovenous bypass (VVB) to veno-arterial bypass (VAB) without requiring a change of circuit and with minimum heparin administration. Furthermore, this circuit provides the added safety of an oxygenator and a heat-exchanger. Utilising the circuit enabled successful resection of the RPS. The patient was discharged from the intensive care unit (ICU) seven days later without any post-operative complications. This case report of a design of a perfusion circuit for the resection of RPS made use of a perfusion approach that had not previously been described and allowed for a reduction in the duration of ischaemic time and retroperitoneal bleeding.
Miraziz
R
R
Department of Perfusion, Westmead Hospital, Sydney, Australia. r_miraziz@yahoo.com.au
Hines
L
L
Brouwer
M
M
Steel
R
R
Klineberg
P
P
D003250:Constriction; D005260:Female; D006801:Humans; D008875:Middle Aged; D010106:Oxygenators; D010477:Perfusion / Q000379:methods*; D015424:Reperfusion; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D012509:Sarcoma / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*