Key result
Novel temporary SVC bypass avoids hemodynamic instability and major complications in 7 reconstruction patients.
Why the study?
Bypass techniques are necessary during SVC clamping in thoracic surgery to avoid hemodynamic instability, cerebral venous hypertension, and hypoperfusion, but simpler methods without full heparinization or pumping devices are needed.
Does a simple temporary SVC bypass technique prevent hemodynamic instability and complications in patients undergoing SVC reconstruction?
Case Report (n=7)
Does a simple temporary SVC bypass technique prevent hemodynamic instability and complications in patients undergoing SVC reconstruction?
A novel, simple temporary SVC bypass technique using standard catheters appears safe and effective in preventing hemodynamic instability and cerebral venous hypertension during SVC reconstruction.
Supports feasibility in SVC reconstruction; hypothesis-generating and should not yet change practice.
Superior vena cava (SVC) clamping can be required during thoracic surgery for SVC replacement or repair. In such cases, bypass techniques can be necessary to avoid hemodynamic instability, cerebral venous hypertension and hypoperfusion. Here, we report a novel and simple SVC bypass technique which does not require full systemic heparinization, specialized cannulation techniques or pumping devices and which can be applied percutaneously in the preoperative phase or intraoperatively. The preoperative shunt consisted in two Swan-Ganz catheters inserted in the jugular and femoral veins and connected by perfusion tubing with a three way stopcock. The intraoperative shunt consisted of a Pruitt(®)-catheter inserted in the left innominate vein and connected to a femoral Swan-Ganz catheter by perfusion tubing. We validated our system in seven patients undergoing SVC reconstruction. We monitored the systemic arterial blood pressures, the heart rate and vasoactive peptide requirements throughout the procedure. We also determined the neurological status and the in-hospital morbidity and mortality for each patient. Using this bypass, SVC clamping caused no hemodynamic instability, no neurological impairments and no in-hospital complications or deaths. This simple temporary SVC bypass procedure is safe and avoids hemodynamic instability and cerebral venous hypertension.
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Perentes et al. (2010) conducted a case report in Patients undergoing SVC reconstruction (n=7). Novel temporary SVC bypass technique was evaluated on Hemodynamic instability, neurological impairments, and in-hospital complications or deaths. A novel temporary SVC bypass technique caused no hemodynamic instability, neurological impairments, or in-hospital complications or deaths in 7 patients undergoing SVC reconstruction.
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