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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.10(1-2)24.2

Abstract

Background: Some tumors arise surrounding the heart, aorta and venacava. Malignant    tumors have distant location with metastasis or encroachment to IVC, aorta and heart. Surgical removal requires cardio-vascular-thoracic surgery and anesthesia facilities  to overcome the devastating complications. Hence the perioperative anaesthetic management and outcome of the non-cardiac tumors with cardiovascular involvement  are studied.  Method: Patients operated in CTVS OR for non-cardiac tumors with extension to  heart and major vessels were studied. It was a retrospective cohort study. The anesthetic management, techniques, special cardiac supports, complications and outcomes  were analysed from the medical records over 2.5yrs. Intraoperative transesophageal  echocardiography (TEE) monitoring was used to guide the management. The data was presented in mean ± SD and percentages. Result: Sixteen patients of 46.5 ± 14.84yr age, weight 64.8 ± 9.81kg were evaluated. Four patients required CPB, deep hypothermic circulatory arrest (DHCA)-1 patient,   one lung ventilation-1 patient, cardiac chamber thrombus formation-4, aorta-IVC-SVCcarotid artery encasement were found in 11. Duration of surgery was 7.87 ± 2.78hrs. Blood loss was from 400-5000ml. Two patients had oliguria, who recovered in 2 days. Eleven patients had malignancy. One patient required lower body DHCA. Para-paresis was   observed in 1 patient after 36hrs of surgery and recovered in 7days. Five patients were   extubated in the OR. Four patients required inotropic support. One patient died on 8th   day from MODS.  Conclusion: The perioperative management of non-cardiac tumors with cardiovascular  extension is unique and challenging. The facilities of cardiovascular team with CPB, onelung ventilation, DHCA, rapid transfusion and TEE were useful for a perfect outcome
 

Keywords : Perioperative, Cardiac Anaesthesia, non-cardiac tumors, Cardiopulmonary Bypass, one lung ventilation, Deep hypothermic circulatory arrest, Transesophageal Echocardiography

Corresponding Author : Sambhunath Das,