Off-Pump Superior Vena Cava Surgery

This is the case of a 59-year-old woman affected by B3/C thymoma. Chemotherapy was complicated by hematological disorders and discontinued after two cycles. She had a partial response to radiotherapy prior to surgery. She then underwent median sternotomy, off-pump left innominate vein reconstruction with an 8 mm Dacron graft, and SVC reconstruction with a 12 mm Dacron graft. On postoperative day two, the SVC graft was revised because of thrombosis. The authors performed Fogarty catheterization of the right jugular and subclavian vein, but subsequently replaced the SVC graft with a 16 mm Dacron graft. The pathologist reported an R0 resection of the thymic cancer.

References

1. Dartavelle PG, Chapelier AR, Pastorino U, Corbi P, Lenot B, Cerrina J, et al. Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Cardiovasc Surg. 1991;102:259–265.
2. Leo F, Bellini R, Conti B, Delledonne V, Tavecchio L, Pastorino U. Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk? Eur J Cardiothorac Surg. 2010 Apr;37(4):764-769.
3. Lee GD, Kim HR, Choi SH, Kim YH, Kim DK, Park SI. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. J Thorac Dis. 2016 Jan;8(1):61-67.
4. Piccione W, Penfield Faber L, Warren WH. Superior vena cava reconstruction using autologous pericardium. Ann Thorac Surg. 1990;50:417–419.

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