Superior Vena Cava Off-Pump Surgery

This is the case of a sixty-four-year-old male patient who was a smoker and with ischemic cardiopathy. He also had a neuroendocrine mediastinal thymic carcinoma involving the superior third of the SVC and the confluence of the two innominate veins. The patient underwent induction chemotherapy (five cycles of CBDCA–VP16) from November 2018 to March 2019.

In this video, the patient underwent an extended radical thymectomy with SVC resection at the confluence of the two innominate veins, prosthetic reconstruction of the left innominate vein to the right atrium with GoreTex 10mm reinforced prosthesis, and tangential reconstruction of the SVC/right innominate vein in through a standard median sternotomy.

The pathologist reported an R0 resection of mediastinal tumor. The patient was discharged uneventfully two weeks after surgery.

References

1)Dartevelle PG, Chapelier AR, Pastorino U, et al. Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Cardiovasc Surg. 1991;102(2):259-265.

2)Spaggiari L, Magdeleinat P, Kondo H, et al. Results of superior vena cava resection for lung cancer. Analysis of prognostic factors. Lung Cancer. 2004;44(3):339-346. doi:10.1016/j.lungcan.2003.11.010

3)Leo F, Bellini R, Conti B, Delledonne V, Tavecchio L, Pastorino U. Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk?. Eur J Cardiothorac Surg. 2010;37(4):764-769. doi:10.1016/j.ejcts.2009.10.024

4)Lanuti M, De Delva PE, Gaissert HA, et al. Review of superior vena cava resection in the management of benign disease and pulmonary or mediastinal malignancies. Ann Thorac Surg. 2009;88(2):392-397. doi:10.1016/j.athoracsur.2009.04.068

5)Maurizi G, Poggi C, D'Andrilli A, et al. Superior Vena Cava Replacement for Thymic Malignancies. Ann Thorac Surg. 2019;107(2):386-392. doi:10.1016/j.athoracsur.2018.08.060