title: Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report.
abstract: BACKGROUND
  Traditionally, tumor thrombi extending into the right atrium have been managed by open surgery with sternotomy, cardiopulmonary bypass circulation and hypothermic circulatory arrest, and are associated with significant morbidity and mortality rates. Here, we evaluate the results of cavoatrial thrombectomy using our own, Foley catheter assisted-technique, obviating the need for thoracotomy, extracorporeal circulation, and/or hypothermic circulatory arrest.
  
  
  METHODS
  Between June 2013 and January 2015, 4 consecutive patients underwent cavoatrial thrombectomy performed with our own, Foley catheter assisted technique, via Chevron incision, with no need for extracorporeal circulation or hypothermy for renal cell carcinoma with tumor thrombus extending into the right atrium. Analyses of patients' data from a prospectively maintained database with respect to perioperative characteristics, morbidity and mortality were performed.
  
  
  RESULTS
  The total mean duration of surgery was 255 minutes. The mean time of total IVC (inferior vena cava) occlusion was 90 seconds. The average blood loss volume, timed from the beginning of cavotomy incision until its closure, was 1200 ml. The total mean intraoperative blood loss was 3,150 ml. There was no perioperative death. Postoperative complications included one transient acute kidney injury requiring one-off hemodialysis and one re-operation due to bleeding. The follow-up time ranged between 12 to 17 months. None of the patients developed disease recurrence. All patients were still alive at the time of study completion.
  
  
  CONCLUSIONS
  Obtained results support the validity of our own, Foley catheter assisted technique, without cardiopulmonary bypass and hypothermic circulatory arrest for the treatment of renal cell carcinoma with tumor thrombus extending into the right atrium.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, the John Paul II Hospital, Cracow, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Sobczyński
authors.affiliation: Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Golabek
authors.affiliation: Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland.
authors.forename: Mikolaj
authors.initials: M
authors.lastname: Przydacz
authors.affiliation: Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wiatr
authors.affiliation: Department of Endocrinology and Diabetes Mellitus, Diabetes Resource Centre, North Tyneside General Hospital, North Shields, United Kingdom.
authors.forename: Jakub
authors.initials: J
authors.lastname: Bukowczan
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, the John Paul II Hospital, Cracow, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
authors.affiliation: Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chłosta
keywords: cavoatrial thrombectomy; complications; renal cell carcinoma