HEPATIC AND VENA-CAVA RESECTION USING CARDIOPULMONARY BYPASS WITH HYPOTHERMIC CIRCULATORY ARREST

When large hepatic or retroperitoneal tumors encroach upon hepatic vei ns or vena cava and make conventional resection hazardous, the most co mmonly used method of hepatic resection or vena cava reconstruction in cludes hepatic vascular exclusion, at times with venovenous bypass or aortic occlusion. These techniques result in warm liver ischemia, and may be accompanied by significant systemic hypotension, despite aggres sive central venous preloading. Hepatic lobe (two patients) and retrop eritoneal sarcoma (one patient) resections were drone in a cold, blood less field without significant complications. Standard cardiopulmonary bypass techniques with heparin and cardioplegia were used. Systemic c irculatory arrest was done at 15 degrees C with isolated retrograde pe rfusion of the brain through the jugular veins. Hepatic vein and vena cava reconstructions were performed with arrest times of between 30 an d 78 minutes. Blood loss was gradual and easily controlled, occurring during the rewarming phase when clot formation was inhibited by cold a nd heparin.