Torabi Asad John, Dobrilovic Nikola, Raman Jai S
Indiana University School of Medicine, Indianapolis, IN, USA.
Rush University Medical Center, Chicago, IL, USA.
Asian Cardiovasc Thorac Ann. 2015 Sep;23(7):809-13. doi: 10.1177/0218492315586488. Epub 2015 May 12.
Vena caval inflow occlusion, despite its utility in pediatrics, is rarely used in adults. We report the use of inflow occlusion in adults when cardiopulmonary bypass is contraindicated.
Between January 1999 and July 2014, 35 patients in 3 hospitals presented with right-sided cardiac lesions; 27 had right-sided endocarditis with sepsis despite maximal medical therapy, the rest had organized sterile masses with embolic potential in the right side of the heart. Comorbidities included immunosuppression, malignancy, and dialysis-dependent renal failure. Twelve patients had heparin-induced thrombocytopenia. Using inflow occlusion on a beating heart, tricuspid valve vegetectomy was performed in 23 patients, vegetectomy and tricuspid valve repair in 3, removal of infected pacing leads in 7, and removal of a migrated inferior vena cava filter in 1. Eight patients had a single 2-min period of vena caval inflow occlusion, and 25 had additional periods of vena caval inflow occlusion after periods of reperfusion. The first 23 procedures were performed through a sternotomy. Nine patients underwent a right minithoracotomy (redo in 2).
There were no deaths. Infected patients had resolution of sepsis and improvement in respiratory status. Three patients had moderate tricuspid regurgitation, the rest had trivial to mild tricuspid regurgitation. One patient had a transient neurological deficit postoperatively, and one had late empyema.
Removal of infective material, sterile masses, and retained foreign bodies can safely be performed under vena caval inflow occlusion when cardiopulmonary bypass is contraindicated.
腔静脉入流阻断术尽管在儿科中有用，但在成人中很少使用。我们报告在体外循环禁忌时在成人中使用入流阻断术的情况。
1999年1月至2014年7月期间，3家医院的35例患者出现右侧心脏病变；27例尽管接受了最大程度的药物治疗仍患有右侧感染性心内膜炎伴败血症，其余患者在心脏右侧有具有栓塞潜能的机化无菌肿块。合并症包括免疫抑制、恶性肿瘤和依赖透析的肾衰竭。12例患者有肝素诱导的血小板减少症。在跳动的心脏上使用入流阻断术，23例患者进行了三尖瓣赘生物切除术，3例进行了赘生物切除和三尖瓣修复，7例进行了感染起搏导线移除，1例进行了移位的下腔静脉滤器移除。8例患者有单次2分钟的腔静脉入流阻断期，25例在再灌注期后有额外的腔静脉入流阻断期。前23例手术通过胸骨切开术进行。9例患者接受了右胸小切口手术（2例为再次手术）。
无死亡病例。感染患者的败血症得到缓解，呼吸状况改善。3例患者有中度三尖瓣反流，其余患者有轻度至轻微三尖瓣反流。1例患者术后有短暂神经功能缺损，1例有晚期脓胸。
在体外循环禁忌时，在腔静脉入流阻断下安全地进行感染物质、无菌肿块和残留异物的清除。
