Surgical treatment of patients with tumor thrombus in the right atrium
Objective: to evaluate the experience of surgical procedures in patients with tumor thrombus in the right atrium. Materials and Methods. From 2007 to 2016, ten patients with tumor thrombus in the right atrium (including six men and four women) underwent the surgery in the RSPC “Cardiology”. Renal cell carcinoma was diagnosed in seven patients, adrenocortical carcinoma - in two patients, and hepatocellular carcinoma - in one patient. Among the complaints at the time of the first visit to a doctor, dyspnea prevailed. Functional class of the NYHA heart failure was 2.0 (2.0, 2.25) at the time of hospitalization. Surgical approaches in addition to median sternotomy were the following: lumbolaparotorotomy in the IX-th intercostal space in four cases, incision of the type “chevron” in three cases, and in one case - median laparotomy incision. In one case, the isolated lumbolaparotorotomy was made in the IX-th intercostal space. Nine surgeries were conducted with cardiopulmonary bypass, seven of them - under moderate hypothermia, and two of them - in normothermia. One surgery was conducted using a temporary shunt. In three cases, there was conducted the plasty of retrohepatic portion of the inferior vena cava with xenopericardium patch. Results. The average time of myocardial ischemia was 47.6±5.5 min, cardiopulmonary bypass time was 148.7±17.1 min, total duration of the surgery was 509±44.7 min. Total blood loss was 2579±699.4 ml on the average, the average duration of respiratory support was 390±96.9 min. Two patients had one large hospital complication each; in a thirty-day period, one patient died. The average follow-up period - 21.9±5 months. Total annual survival rate was 78.8±13.4%, three- year survival rate - 52.5±13.6%, the median of survival - 37±8.5 months. Conclusions. Radical excision of the primary tumor en bloc with tumor thrombus in the inferior vena cava and right atrium is the main method of treatment of patients with this pathology, despite the technical complexity and the need of multidisciplinary approach. It increases life expectancy and relieves the symptoms.