title: Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy.
abstract: OBJECTIVE
  To summarise the experiences of applying vena cava endovascular occlusion technique in minimally invasive isolated redo tricuspid surgery.
  
  
  METHODS
  Forty-six consecutive patients received minimally invasive redo tricuspid surgery through right thoracotomy at our institute. All the patients had isolated significant tricuspid regurgitation after previous cardiac surgeries. Preoperative chest computed tomography showed high risk of conventional median sternotomy and vena cava exposure. A right anterolateral thoracotomy incision was made from the fourth intercostal space. The arterial cannula was placed in femoral artery, and balloon cannulas were used for bicaval cannulation. The venous cannulation was guided by transoesophageal echocardiography. Tricuspid valve operation was performed with heart beating after both venous cannulas were endovascularly occluded by inflating the balloons.
  
  
  RESULTS
  There were no complications related to this cannulation technique. Two patients needed position adjustment or re-inflation of the balloon to obtain complete occlusion. The average time of cardiopulmonary bypass establishment was 55 ± 15 min and pump time was 58 ± 23 min. The length of stay was 8 ± 7 days. There was no early death in hospital.
  
  
  CONCLUSIONS
  Endovascular occlusion of both vena cava in isolated redo tricuspid surgery was safe, effective and reliable. This approach significantly simplified the complexity of the surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Zhaolei
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China. Electronic address: ju_mei63@126.com.
authors.forename: Ju
authors.initials: J
authors.lastname: Mei
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Fangbao
authors.initials: F
authors.lastname: Ding
authors.affiliation: Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
authors.forename: Saie
authors.initials: S
authors.lastname: Shen
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Jiaquan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Junwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Yin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013908:Thoracotomy / Q000379:methods*; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery*
keywords: Cardiopulmonary bypass; Endovascular occlusion; Minimally invasive surgery; Transoesophageal echocardiography; Tricuspid regurgitation