Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible.

Shixin Zhang,Meng Tang,Haidong Wang,Hongxiang Liu,Aihong Huang,Ming Zhang,Tao Wu,Mei Xia,Bo He,Qiao Chen,Deli Tan,Wei Wu,Tao Jing,Lingfeng Tang,Yang Qiu,Yi Liao,Jinghua Tang,Ni Zhou

doi:10.1111/1759-7714.13140

Shixin Zhang, Meng Tang + Show 16 more

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https://doi.org/10.1111/1759-7714.13140

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Journal: Thoracic cancer	Publication Date: Jul 12, 2019
Citations: 6	License type: CC BY 4.0

Affiliation: Army Medical University

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BackgroundHow to maximally improve the drainage of intracranial and upper body venous and to reduce neurological complications during thoracic tumor‐causedsuperior vena cava replacement are still clinical problems to be solved.MethodsWe have innovatively used the bilateral jugular vein‐left femoral vein ECMO shunting to perform mediastinal tumor resection and superior vena cava replacement in a 50‐year‐old woman.ResultsDuring the operation, this technique maintained the patient's hemodynamic stability, improved the cerebral oxygen saturation and reduced the cerebral ischemia, hypoxia as well as the neurological complications.ConclusionIt is indicated for patients with superior vena cava replacement who are unable to perform venous bypass (such as innominate vein to right atrial bypass) or venous shunting (such as differential pressure drainage from internal jugular vein to femoral vein).

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Most patients with locally advanced lung cancer with superior vena cava invasion and invasive thymoma need to undergo superior vena cava resection and artificial vascular replacement during radical resection, which can improve their short- and long-term survival rate.[1,2,3] in the process of vascular replacement, the superior vena cava should be occluded
In the process of vascular replacement, the superior vena cava should be occluded. It causes a decrease in venous return and an increase in cerebral venous pressure which may result in hemodynamic instability and cerebral hypoperfusion, or even ischemia and hypoxia
After the Preoperative multidisciplinary consultation and discussion, we thought: (i) The tumor invaded the left innominate vein and superior vena cava, and the tumor thrombus was observed in the superior vena cava which needed to be replaced (Fig 1a,b). (ii) If the uninvaded left innominate vein was long enough a left innominate vein to right atrial bypass could be performed, otherwise an internal jugular vein to femoral vein shunt could be established. (iii) After shunting, if the patient had a decrease of blood pressure and an increase of jugular venous pressure (CVP >40 mmHg), a V-V ECMO bypass should be initiated to strengthen the shunt

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Introduction

Most patients with locally advanced lung cancer with superior vena cava invasion and invasive thymoma need to undergo superior vena cava resection and artificial vascular replacement during radical resection, which can improve their short- and long-term survival rate.[1,2,3] in the process of vascular replacement, the superior vena cava should be occluded. It causes a decrease in venous return and an increase in cerebral venous pressure which may result in hemodynamic instability and cerebral hypoperfusion, or even ischemia and hypoxia. Conclusion: It is indicated for patients with superior vena cava replacement who are unable to perform venous bypass (such as innominate vein to right atrial bypass) or venous shunting (such as differential pressure drainage from internal jugular vein to femoral vein).

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