Division of Thoracic Surgery, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy.
Eur J Cardiothorac Surg. 2011 Dec;40(6):1487-91; discussion 1491. doi: 10.1016/j.ejcts.2011.03.008. Epub 2011 May 6.
Artificial prosthesis of the superior vena cava (SVC) may occlude with time. For this reason, we proposed in 2003 the use of a biological material (bovine pericardium) and devised an original technique to construct the prosthetic conduit. We hereby report the long-term results in 15 patients.
The SVC prosthetic conduit is realized by wrapping a bovine pericardial leaflet around a 5 or 10 cm(3) syringe and stapling it on the side by a 60-80 linear stapler. This procedure is carried out intra-operatively after the size of the patient's SVC has been ascertained; the conduit is then cut to the appropriate length. We have employed this technique in 15 patients with lung (eight) or mediastinal (seven) tumors; after a minimum follow-up of 1 year, all patients underwent computed tomographic-volume rendering (CT-VR) studies of the SVC.
Technically, the stapled pericardial conduit has several advantages: (1) it is simple and expeditious; (2) it allows an even and regular suture line, which cannot be achieved by hand suturing; (3)'one size fits all': with one single pericardial leaflet, conduits of all sizes can be realized; this is important for an operation which is performed only few times per year; (4) patency is granted by the intrinsic rigidity of the pericardium and staple line, without the need for any reinforcement; (5) different calibers at the two extremities can be obtained by simply placing the stapler obliquely; and (6) the staple line is excellent for the orientation of the conduit while suturing. In our patients, SVC clamping time ranged between 18 and 50 min (mean 29 min); one patient needed cardiopulmonary bypass. Intra-operative anticoagulation (1.500-2.500 units of heparin) was continued postoperatively subcutaneously for 7 days and then shifted to oral anticoagulation for 6 months. One patient died postoperatively of heart failure (mortality 6%). One to 5 years after surgery, CT-VR showed full patency of the pericardial conduit, no clots or thrombus formation, and absence of collateral venous circulation in all 14 patients. One- and 5-year survival was 93% and 73%, respectively (Kaplan-Meier).
The stapled bovine pericardial conduit is a simple, expeditious, and economic solution to SVC replacement, and offers reliable long-term patency without permanent anticoagulation.
上腔静脉（SVC）的人工假体可能会随着时间的推移而堵塞。出于这个原因，我们在 2003 年提出使用生物材料（牛心包）并设计了一种原始技术来构建假体管道。在此，我们报告了 15 例患者的长期结果。
SVC 假体管道是通过将牛心包片包裹在 5 或 10 cm3 的注射器周围并用 60-80 线性吻合器在侧面缝合来实现的。在确定患者 SVC 的大小后，在手术中进行此程序；然后将管道切割至适当的长度。我们在 15 例患有肺部（8 例）或纵隔（7 例）肿瘤的患者中使用了这种技术；在至少 1 年的随访后，所有患者均接受了 SVC 的计算机断层扫描容积渲染（CT-VR）研究。
技术上，缝合的心包导管具有以下几个优点：（1）它简单快捷；（2）它可以实现均匀且规则的缝线，这是手工缝合无法实现的；（3）“一种尺寸适合所有”：使用单个心包片，可以实现所有尺寸的导管；这对于每年仅进行几次的手术非常重要；（4）通过心包和吻合线的固有刚性来保证通畅性，无需任何加固；（5）通过将吻合器倾斜放置，可以获得两端不同的口径；（6）在缝合时，吻合线非常适合导管的定向。在我们的患者中，SVC 夹闭时间为 18 至 50 分钟（平均 29 分钟）；1 例患者需要心肺旁路。术中抗凝（1500-2500 单位肝素）在术后继续皮下使用 7 天，然后转为口服抗凝 6 个月。术后 1 例患者死于心力衰竭（死亡率 6%）。术后 1 至 5 年，CT-VR 显示所有 14 例患者的心包导管完全通畅，无血栓形成或血栓形成，无侧支静脉循环。1 年和 5 年生存率分别为 93%和 73%（Kaplan-Meier）。
缝合的牛心包导管是一种简单、快捷、经济的 SVC 置换方法，无需长期持续抗凝即可提供可靠的通畅性。
