Application of retrograde cerebral perfusion and moderate systemic hypothermic circulatory arrest for cavoatrial tumor resection

Renal tumors invading the inferior vena cava have proved to be surgically challenging. For suprahepatic and right atrial involvement, deep hypothermic circulatory arrest (HCA) has been the favored procedure. Retrograde cerebral perfusion (RCP) was combined with moderate HCA in an effort to improve cerebral protection and avoid neurological sequelae. Six patients (mean age 64.7 years) who were operated on using this technique underwent a retrospective medical record analysis. The six patients achieved a mean cardiopulmonary bypass, HCA, and RCP time of 2 hours 34 minutes, 26.5 minutes, and 22 minutes, respectively. There were no focal cerebral defects or mortalities. Transient cerebral events were avoided compared to previous patients subjected to deeper hypothermia. All patients are living with no evidence of cancer 16-30 months after surgery. The addition of RCP to HCA for resection of supradiaphragmatic renal carcinoma enhances cerebral protection and allows time for a more efficacious operative procedure.