A. Torabi1, N. Dobrilovic2, J. Raman2 1Indiana University School Of Medicine,Indianapolis, IN, USA 2Rush University Medical Center,Chicago, IL, USA
Introduction: Vena Caval inflow occlusion (VCIO) is an old technique that has been used with success in the pediatric population. Few reports exist of its use in adults. We report on the use of inflow occlusion in removing infected material, and complex masses from the right side of the heart.
Methods: Between January, 1999 and July, 2014, thirty-five patients in three hospitals in Australia and North America presented with right sided endocarditis, worsening respiratory status and systemic sepsis, in spite of maximal medical therapy or organized sterile masses with embolic potential in the right side of the heart. Twenty of them were immunosuppressed due to concomitant medical conditions or, malignancy. Fifteen of these patients were on hemodialysis with organized thrombi related to long-standing access catheters. Twelve patients had heparin-induced thrombocytopenia. Tricuspid vegetectomy was performed in 23 under VCIO, while closure of a patent foramen ovale (PFO) was performed in four patients, tricuspid valve repair in 3. Removal of infected pacing leads was performed in seven and removal of a migrated IVC filter in another. Eighteen patients had a single 2-minute period of VCIO, while the others had additional periods of VCIO after a period of 5 minutes of reperfusion. The first 23 procedures were performed through a sternotomy with bilateral decortication of the lungs. Nine patients underwent right mini-thoracotomy and two of them were in the setting of redo cardiac surgery. One patient had a repeat VCIO procedure through a sternotomy after a previous thoracotomy.
Results: There were no deaths. All patients had resolution of sepsis. Three patients had moderate tricuspid regurgitation (TR), while the others had trivial to mild TR. One patient had a transient neurological deficit post-operatively and one patient required a late decortication of an empyema.
Conclusion: Tricuspid and right atrial procedures can be performed safely off-pump using vena caval inflow occlusion in high-risk patients.