Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Cryopreserved Graft Reconstruction

• DOI: 10.1053/j.semtcvs.2012.02.002
• Publication Date: 2012-03-21T11:47:42Z
• Authors: Massimo Jaus; Paolo Macchiarini
• Keywords: Adult; Bioprosthesis; Cryopreservation; Male; Vena Cava, Superior; Patient Selection; Middle Aged; Plastic Surgery Procedures; Thoracic Neoplasms; Thoracic Surgical Procedures; Blood Vessel Prosthesis; 3. Good health; Blood Vessel Prosthesis Implantation; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Transplantation, Homologous; Female; Neoplasm Invasiveness; Aged; Brachiocephalic Veins

Recent technical advances in the domains of anesthesia, cardiovascular and thoracic surgery, and synthetic materials manufacturing coupled with more oncological extended tumor indications have unlocked the door to the surgical treatment of pulmonary, mediastinal, or other rare tumors involving intrathoracic vessels. In 1987, Dartevelle et al1 first described a consecutive and large series of patients with mediastinal or lung malignancies and superior vena cava (SVC) involvement treated with SVC resection by using polytetrafluoroethylene tubular grafts for reconstruction. Open surgery requires a high level of technical expertise and vigilant attention to patient selection and perioperative management to minimize complications, which are reported even in highly specialized centers.1,2 During the past decade, operative mortality for these procedures has ranged between 0% and 7.7%, with long-term patency rates of about 70%-100%.3-9 However, proper patient selection is critical for clinical success. We will outline the role of surgery for selected patients with locally advanced but completely resectable non-small cell lung cancers (NSCLC) or mediastinal tumors (MT) involving invading the SVC and/or the innominate vein (IV).