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Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium
OBJECTIVES Renal cell carcinoma with a tumour thrombus extending into the right heart chambers necessitates extensive combined urological and cardiac surgery. Maximum safety and exactness in extirpation of the caval and intracardiac thrombus is achieved under deep hypothermic circulatory arrest, at...
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Published in: | Interactive cardiovascular and thoracic surgery 2014-04, Vol.18 (4), p.411-414 |
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creator | Zacek, Pavel Dominik, Jan Brodak, Milos Louda, Miroslav |
description | OBJECTIVES
Renal cell carcinoma with a tumour thrombus extending into the right heart chambers necessitates extensive combined urological and cardiac surgery. Maximum safety and exactness in extirpation of the caval and intracardiac thrombus is achieved under deep hypothermic circulatory arrest, at a price of its non-physiological burden and time constraints. We propose a simple surgical manoeuvre enabling selective arch perfusion allowing for a milder hypothermia and liberal interval of circulatory arrest.
METHODS
On a routine cardiopulmonary bypass via median sternotomy, the dissection is extended along the aortic arch to identify the origins of the supra-aortic vessels. After standard aortic cross-clamping and cardioplegic cardiac arrest at moderate hypothermia, a second cross-clamp is applied at the aortic arch beyond the left carotid artery. A selective closed aortic arch perfusion is started while the extirpation of the tumour thrombus from the right atriotomy and abdominal cavotomy is being performed under conditions of circulatory arrest.
RESULTS
Using selective aortic arch perfusion, successful and uncomplicated extirpation of voluminous caval and intracardiac tumour thrombi was accomplished in 3 presented patients. Unexpectedly difficult thrombus adhering to hepatic veins in 1 patient required 42 min of circulatory arrest. Postoperative courses were uneventful in all 3 patients.
CONCLUSIONS
Second aortic cross-clamp to start selective closed aortic arch perfusion provides excellent surgical control of the operative field over a liberal time interval during circulatory arrest under milder hypothermia. |
doi_str_mv | 10.1093/icvts/ivt545 |
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fullrecord | <record><control><sourceid>proquest_TOX</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3957292</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/icvts/ivt545</oup_id><sourcerecordid>1508681602</sourcerecordid><originalsourceid>FETCH-LOGICAL-c416t-dce00f3a12b14e2b83836d0f81a3ba791ccf5aecfc0d6d95bfd13e4ac9e03eff3</originalsourceid><addsrcrecordid>eNp9kc2P1SAUxYnROB-6c23Y6WKeA6V0ysbETPxKJnGhrgmllymmLfUC1fdn-R9K540vunEDJJzzOzf3EPKMs1ecKXHp7ZripV-TrOUDcsplo3aqauXD41uJE3IW4zfGuGKCPSYnVS3aWjJ2Sn59hhFs8itQEzB5Sw3agS6ALkcfZgqz6UaINAVq1uB72gMsdNgvIQ2AUzFYjzaPJgXcFzNCTNQFpPAzeVxM2iDBUSygkVoYy1Ei_BwmQ3_4NNCUp5CRpgHD1OW4GWG-y_ZzSS0xFP3tkKhJ6PP0hDxyZozw9P4-J1_fvf1y_WF38-n9x-s3Nztb8ybteguMOWF41fEaqq4VrWh65lpuRGeuFLfWSQPWWdY3vZKd67mA2lgFTIBz4py8PnCX3E1QcHNCM-oF_WRwr4Px-t-f2Q_6NqxaKHlVqaoAXt4DMHzPZS168nFbgJkh5Ki5ZG3T8oZt0ouD1GKIEcEdYzjTW8v6rmV9aLnIn_892lH8p9YieHEQhLz8H_Ubjju7jg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1508681602</pqid></control><display><type>article</type><title>Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium</title><source>Open Access: Oxford University Press Open Journals</source><creator>Zacek, Pavel ; Dominik, Jan ; Brodak, Milos ; Louda, Miroslav</creator><creatorcontrib>Zacek, Pavel ; Dominik, Jan ; Brodak, Milos ; Louda, Miroslav</creatorcontrib><description>OBJECTIVES
Renal cell carcinoma with a tumour thrombus extending into the right heart chambers necessitates extensive combined urological and cardiac surgery. Maximum safety and exactness in extirpation of the caval and intracardiac thrombus is achieved under deep hypothermic circulatory arrest, at a price of its non-physiological burden and time constraints. We propose a simple surgical manoeuvre enabling selective arch perfusion allowing for a milder hypothermia and liberal interval of circulatory arrest.
METHODS
On a routine cardiopulmonary bypass via median sternotomy, the dissection is extended along the aortic arch to identify the origins of the supra-aortic vessels. After standard aortic cross-clamping and cardioplegic cardiac arrest at moderate hypothermia, a second cross-clamp is applied at the aortic arch beyond the left carotid artery. A selective closed aortic arch perfusion is started while the extirpation of the tumour thrombus from the right atriotomy and abdominal cavotomy is being performed under conditions of circulatory arrest.
RESULTS
Using selective aortic arch perfusion, successful and uncomplicated extirpation of voluminous caval and intracardiac tumour thrombi was accomplished in 3 presented patients. Unexpectedly difficult thrombus adhering to hepatic veins in 1 patient required 42 min of circulatory arrest. Postoperative courses were uneventful in all 3 patients.
CONCLUSIONS
Second aortic cross-clamp to start selective closed aortic arch perfusion provides excellent surgical control of the operative field over a liberal time interval during circulatory arrest under milder hypothermia.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivt545</identifier><identifier>PMID: 24384500</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aorta, Thoracic - physiopathology ; Aorta, Thoracic - surgery ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Cardiac Surgical Procedures - adverse effects ; Circulatory Arrest, Deep Hypothermia Induced - adverse effects ; Female ; Heart Atria - pathology ; Heart Atria - surgery ; Humans ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Male ; Middle Aged ; Neoplasm Invasiveness ; Nephrectomy - adverse effects ; NEW IDEAS ; Operative Time ; Perfusion - adverse effects ; Perfusion - methods ; Regional Blood Flow ; Time Factors ; Treatment Outcome</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2014-04, Vol.18 (4), p.411-414</ispartof><rights>The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-dce00f3a12b14e2b83836d0f81a3ba791ccf5aecfc0d6d95bfd13e4ac9e03eff3</citedby><cites>FETCH-LOGICAL-c416t-dce00f3a12b14e2b83836d0f81a3ba791ccf5aecfc0d6d95bfd13e4ac9e03eff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957292/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957292/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1604,27924,27925,53791,53793</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/icvts/ivt545$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24384500$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zacek, Pavel</creatorcontrib><creatorcontrib>Dominik, Jan</creatorcontrib><creatorcontrib>Brodak, Milos</creatorcontrib><creatorcontrib>Louda, Miroslav</creatorcontrib><title>Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>OBJECTIVES
Renal cell carcinoma with a tumour thrombus extending into the right heart chambers necessitates extensive combined urological and cardiac surgery. Maximum safety and exactness in extirpation of the caval and intracardiac thrombus is achieved under deep hypothermic circulatory arrest, at a price of its non-physiological burden and time constraints. We propose a simple surgical manoeuvre enabling selective arch perfusion allowing for a milder hypothermia and liberal interval of circulatory arrest.
METHODS
On a routine cardiopulmonary bypass via median sternotomy, the dissection is extended along the aortic arch to identify the origins of the supra-aortic vessels. After standard aortic cross-clamping and cardioplegic cardiac arrest at moderate hypothermia, a second cross-clamp is applied at the aortic arch beyond the left carotid artery. A selective closed aortic arch perfusion is started while the extirpation of the tumour thrombus from the right atriotomy and abdominal cavotomy is being performed under conditions of circulatory arrest.
RESULTS
Using selective aortic arch perfusion, successful and uncomplicated extirpation of voluminous caval and intracardiac tumour thrombi was accomplished in 3 presented patients. Unexpectedly difficult thrombus adhering to hepatic veins in 1 patient required 42 min of circulatory arrest. Postoperative courses were uneventful in all 3 patients.
CONCLUSIONS
Second aortic cross-clamp to start selective closed aortic arch perfusion provides excellent surgical control of the operative field over a liberal time interval during circulatory arrest under milder hypothermia.</description><subject>Aged</subject><subject>Aorta, Thoracic - physiopathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Circulatory Arrest, Deep Hypothermia Induced - adverse effects</subject><subject>Female</subject><subject>Heart Atria - pathology</subject><subject>Heart Atria - surgery</subject><subject>Humans</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Invasiveness</subject><subject>Nephrectomy - adverse effects</subject><subject>NEW IDEAS</subject><subject>Operative Time</subject><subject>Perfusion - adverse effects</subject><subject>Perfusion - methods</subject><subject>Regional Blood Flow</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNp9kc2P1SAUxYnROB-6c23Y6WKeA6V0ysbETPxKJnGhrgmllymmLfUC1fdn-R9K540vunEDJJzzOzf3EPKMs1ecKXHp7ZripV-TrOUDcsplo3aqauXD41uJE3IW4zfGuGKCPSYnVS3aWjJ2Sn59hhFs8itQEzB5Sw3agS6ALkcfZgqz6UaINAVq1uB72gMsdNgvIQ2AUzFYjzaPJgXcFzNCTNQFpPAzeVxM2iDBUSygkVoYy1Ei_BwmQ3_4NNCUp5CRpgHD1OW4GWG-y_ZzSS0xFP3tkKhJ6PP0hDxyZozw9P4-J1_fvf1y_WF38-n9x-s3Nztb8ybteguMOWF41fEaqq4VrWh65lpuRGeuFLfWSQPWWdY3vZKd67mA2lgFTIBz4py8PnCX3E1QcHNCM-oF_WRwr4Px-t-f2Q_6NqxaKHlVqaoAXt4DMHzPZS168nFbgJkh5Ki5ZG3T8oZt0ouD1GKIEcEdYzjTW8v6rmV9aLnIn_892lH8p9YieHEQhLz8H_Ubjju7jg</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Zacek, Pavel</creator><creator>Dominik, Jan</creator><creator>Brodak, Milos</creator><creator>Louda, Miroslav</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140401</creationdate><title>Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium</title><author>Zacek, Pavel ; Dominik, Jan ; Brodak, Milos ; Louda, Miroslav</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-dce00f3a12b14e2b83836d0f81a3ba791ccf5aecfc0d6d95bfd13e4ac9e03eff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aorta, Thoracic - physiopathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Cardiac Surgical Procedures - adverse effects</topic><topic>Circulatory Arrest, Deep Hypothermia Induced - adverse effects</topic><topic>Female</topic><topic>Heart Atria - pathology</topic><topic>Heart Atria - surgery</topic><topic>Humans</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Invasiveness</topic><topic>Nephrectomy - adverse effects</topic><topic>NEW IDEAS</topic><topic>Operative Time</topic><topic>Perfusion - adverse effects</topic><topic>Perfusion - methods</topic><topic>Regional Blood Flow</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zacek, Pavel</creatorcontrib><creatorcontrib>Dominik, Jan</creatorcontrib><creatorcontrib>Brodak, Milos</creatorcontrib><creatorcontrib>Louda, Miroslav</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Zacek, Pavel</au><au>Dominik, Jan</au><au>Brodak, Milos</au><au>Louda, Miroslav</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>18</volume><issue>4</issue><spage>411</spage><epage>414</epage><pages>411-414</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>OBJECTIVES
Renal cell carcinoma with a tumour thrombus extending into the right heart chambers necessitates extensive combined urological and cardiac surgery. Maximum safety and exactness in extirpation of the caval and intracardiac thrombus is achieved under deep hypothermic circulatory arrest, at a price of its non-physiological burden and time constraints. We propose a simple surgical manoeuvre enabling selective arch perfusion allowing for a milder hypothermia and liberal interval of circulatory arrest.
METHODS
On a routine cardiopulmonary bypass via median sternotomy, the dissection is extended along the aortic arch to identify the origins of the supra-aortic vessels. After standard aortic cross-clamping and cardioplegic cardiac arrest at moderate hypothermia, a second cross-clamp is applied at the aortic arch beyond the left carotid artery. A selective closed aortic arch perfusion is started while the extirpation of the tumour thrombus from the right atriotomy and abdominal cavotomy is being performed under conditions of circulatory arrest.
RESULTS
Using selective aortic arch perfusion, successful and uncomplicated extirpation of voluminous caval and intracardiac tumour thrombi was accomplished in 3 presented patients. Unexpectedly difficult thrombus adhering to hepatic veins in 1 patient required 42 min of circulatory arrest. Postoperative courses were uneventful in all 3 patients.
CONCLUSIONS
Second aortic cross-clamp to start selective closed aortic arch perfusion provides excellent surgical control of the operative field over a liberal time interval during circulatory arrest under milder hypothermia.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>24384500</pmid><doi>10.1093/icvts/ivt545</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aorta, Thoracic - physiopathology Aorta, Thoracic - surgery Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Cardiac Surgical Procedures - adverse effects Circulatory Arrest, Deep Hypothermia Induced - adverse effects Female Heart Atria - pathology Heart Atria - surgery Humans Kidney Neoplasms - pathology Kidney Neoplasms - surgery Male Middle Aged Neoplasm Invasiveness Nephrectomy - adverse effects NEW IDEAS Operative Time Perfusion - adverse effects Perfusion - methods Regional Blood Flow Time Factors Treatment Outcome |
title | Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium |
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