**2. Case series description**

#### **2.1 Patient's population**

During the period between February 2020 and February 2023, four patients underwent surgery due to different cardiac pathology at the two institutions ("Sechenov University" and "Chelyabinsk Regional Clinical Hospital"). All patients, their clinical course, and surgical interventions were considered exclusive regarding technique and cardiac valve allografts implanted. This study was approved by the Regional Ethics Committee of each hospital, and all patients signed their informed consent. The overall patient characteristic is depicted in **Table 1**.

#### **2.2 Inferior vena cava replacement with pulmonary homograft**

A 60-year-old woman with a clinical picture of dyspnea, weakness, and discomfort on moderate physical exertion was admitted to the Clinic of Faculty Surgery No. 1 of "Sechenov University". From the previous medical history, there was evidence of a left-sided hemicolectomy performed in 2017 for splenic flexure transverse colon cancer pT4AN2AM0 (TNM 8, histologically moderately differentiated adenocarcinoma). The patient was further operated on twice for liver metastases in 2018 (liver segments 2, 3, and 4A were resected) and in 2019 (liver segmentectomy IV b (the number of segment) was performed). The patient received a total of 8 courses of poly-chemotherapy. Initial investigation showed subtotal thrombosis of the right atrium due to tumor involvement of the vena cava and atrium wall. Contrast-enhanced computed tomography (CT) revealed a hepatic segment I metastasis with inferior vena cava thrombosis, spreading into the right atrial cavity. Thrombotic masses in the right atrial lumen were confirmed by transesophageal echocardiography (TEE).

The patient was scheduled for median sternotomy and upper median laparotomy approach that was performed on February 5, 2020. The stage of mobilization and removal of the first segment of the liver was performed before cardiopulmonary bypass. Standard ascending aorta, superior vena cava, and inferior vena cava in the infrahepatic segment bypass were initiated. After adhesiolysis, the superior vena cava and inferior vena cava (IVC) were snared, and a longitudinal cavatomy was performed. Invasion of the inferior vena cava wall into the tumorous process was revealed. Thrombotic masses were visualized that spread into the right atrium and were fixed to its wall; the tricuspid valve was intact. Radical excision of the tumor masses entailed resectioning the right atrium and inferior vena cava area with subsequent replacement of the part of inferior vena cava and right atrium wall with a cryopreserved pulmonary homograft (28 mm in diameter). The cardiopulmonary bypass time was 67 minutes. The resected tumor, inferior vena cava, and the final view after reconstruction are shown in **Figures 1** and **2**.

In the 3-year follow-up period, transthoracic echocardiography and contrastenhanced CT depicted no evidence of tumor recurrence.

*Clinical Implication of Cardiac Valve Allografts in Rare Surgical Circumstances DOI: http://dx.doi.org/10.5772/intechopen.112865*


**Table 1.**

*The overall patient's characteristic.*

**Figure 1.** *Intraoperative view. Tumor mass deleted from the inferior vena cava.*
