Right heart bypass without an oxygenator as an alternative technique for surgical management of right-sided heart problems: a case report

Introduction: Lead-related infective endocarditis is a rare complication with a high mortality rate that needs to be addressed immediately. In most cases, surgery is mandatory in addition to medical treatment. Alternative techniques to conventional cardiopulmonary bypass have been developed to reduce the inflammatory response and post-operative complications. Case presentation: A 29-year-old male patient with a dual-chamber implantable cardioverter defibrillator presented to our hospital with infective endocarditis. Early evaluation of the patient revealed a large mobile 6*2 cm vegetation attached to the leads and tricuspid valve and the right atrium. Due to large size of the vegetation, the patient got prepared for surgical removal of the vegetation. The patient underwent right heart bypass with cannulation of the inferior and superior vena cava and the pulmonary artery. Discussion: The inflammatory response subsequent to cardiopulmonary bypass plays an important role in postoperative complications such as pulmonary complication including transient hypoxemia or even more severe complication like acute respiratory distress syndrome. Additionally, the ascending aorta manipulation may result in postoperative cerebral atheroembolism and stroke. In selected patients, right heart bypass is a better option, as cardioplegic arrest is not needed in this technique, and a less post-operative inflammatory response is expected due to the absence of long tubes, an oxygenator, and aortic clamping. Conclusion: Right heart bypass could be a less complicated, safer, and cost-benefit alternative to conventional cardiopulmonary bypass in the case of right-sided heart problems. This technique allows effective decompression of the right heart and adequate oxygenation without postoperative complications, usually seen in routine cardiopulmonary bypass.