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Bridging circuit for the resection of retroperitoneal sarcoma involving the aorta and the IVC - veno-venous to veno-arterial perfusion

Department of Perfusion, Westmead Hospital, Sydney, Australia r_miraziz{at}yahoo.com.au

L Hines

Department of Perfusion, Westmead Hospital, Sydney, Australia

M Brouwer

Department of Perfusion, Westmead Hospital, Sydney, Australia

R Steel

Department of Perfusion, Westmead Hospital, Sydney, Australia

P Klineberg

Department of Perfusion, Westmead Hospital, Sydney, Australia

A 50-year-old female underwent surgery for removal of a massive retroperitoneal sarcoma (RPS) involving the right hepatic lobe and the inferior vena cava (IVC), abdominal aorta, right lung, right hemi-diaphragm and pericardium. Resection of the RPS necessitated cross-clamping of the abdominal aorta, IVC and the hepatic artery. Cross-clamp time cannot be predicted prior to tumour resection and vascular re-construction. To prevent complications of prolonged cross-clamp time and distal hypo-perfusion, circulatory support was sought to facilitate the procedure. A perfusion circuit was designed to accommodate an easy and immediate redirection of blood flow from veno-venous bypass (VVB) to veno-arterial bypass (VAB) without requiring a change of circuit and with minimum heparin administration. Furthermore, this circuit provides the added safety of an oxygenator and a heat-exchanger. Utilising the circuit enabled successful resection of the RPS. The patient was discharged from the intensive care unit (ICU) seven days later without any post-operative complications. This case report of a design of a perfusion circuit for the resection of RPS made use of a perfusion approach that had not previously been described and allowed for a reduction in the duration of ischaemic time and retroperitoneal bleeding.

Key Words: retroperitoneal sarcoma • veno-arterial bypass • veno-venous bypass

Perfusion, Vol. 23, No. 1, 65-69 (2008)
DOI: 10.1177/0267659108093879


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