**7. References**


cava metastathic thrombosis. In this operation, we used the MECC system to cool the patients during the isolation of renal tumor mass. The two surgical equips could work contemporaneously. Once the patients reaches the body temperature of 20 °C, the MECC system was converted in a standard ECC to drained all the blood and arrested the systemic circulation. Once the thrombus was from the inferior vena cava and the vessel was sutured, we restarted the systemic circulation and the standard ECC was converted in MECC system. We preferred to use this strategy to reduce the risk of bleeding from the abdomen, which is

We did not find in the literature significant differences in terms of clinical results regarding post-operative mortality. One of the reasons is because the MECC strategy is widely applied in low risk populations and only few Authors describe the use of MECC in high-risk patients (Puehler 2011, Koivisto 2010). At the moment, most of the clinical benefits with the

The good amount of data described in favor of MECC could induce to apply this strategy in more cardiac surgical operations. However, the MECC system presents some limitations that create some concern about a wider use of this technique. One important limitation is high risk of air entrapment along the venous line that could suddenly stop the cardiopulmonary bypass. Another limitation is the need of learning curve because, as well as in the OPCAB, the MECC technique requires an experienced team (surgeon, anesthesiologist and perfusion) before to be applied routinely in all CABG patients and by

We feel that the MECC technology gives better advantages than standard ECC and we feel that MECC could be applied to other surgical procedures. Of course more randomized, large, multicenter studies are mandatory to verify the safety of this technology in such

The Authors thank Dr. Giorgia Pavan for her editing assistance during the preparation of

Anastasiadis, K., Chalvatzoulis, O., Antonitsis, P., Deliopoulos, A., Argiriadou, H.,

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Karapanagiotidis, G., Kambouroglou, D. & Papakonstantinou C. (2011). Neurocognitive outcome after coronary artery bypass surgery using minimal versus conventional extracorporeal circulation: a randomised controlled pilot

use of MECC were seen in the SIRS, hemodilution, platelet function protection.

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the chapter and Dr. Silvia Mariani for her support about literature search.

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very high in such tumoral pathologies.

**5. Conclusion** 

all surgical staff.

**6. Acknowledgment** 

**7. References** 


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**8** 

*Italy* 

**Hypothermic Cardiac Arrest to Remove Right** 

Pier Luigi Stefano, Stefano Romagnoli, Donata Villari and Giacomo Batignani

*Università degli Studi di Firenze,* 

**Atrial Thrombi Due to Abdominal Malignancies** 

The first use of hypothermia in cardiac surgery is attributed to Dr. John Lewis who performed an atrial septal defect closure on September 2, 1952 at the University of

Cardiopulmonary by-pass (CPB) and hypothermic cardio-circulatory arrest (HCCA) has been introduced for the first time in clinical practice for aortic arc substitution (Pierangeli et al., 1974). More recently the same technique has been proposed to remove atrial thrombi originated from renal carcinomas (Marshall et al., 1984), adrenal carcinomas (Shahinian et al., 1989), hepatocellular carcinoma (Hamazaki et al., 1995) and other abdominal malignancies such as caval leiomyosarcoma, uterine endometrial sarcoma or intravenous leiomyomatosis, ovarian or testicular tumors (Hassan et al.,, 2010; Vargas-Barron et al., 1990;

There is still a debate pro and cons the use of hypothermic arrest with some favours the normothermic (Lubahn et al., 2006; Stewart et al., 1991) and some others the hypothermic, because of the operative field appears better exposed and almost completely bloodless so the blood loss resulted much lower. Furthermore they claim a better visualization of some critical areas with an easier removal of the tumoural thrombus, that may invade the hepatic veins or the coronaric sinus, may either remain attached to the tricuspid valve or may have embolized into the pulmonary artery (Chiappini et al., 2002; Kalkat et al., 2008; Leo et al., 2010; Topcouglu et al., 2004). In all these occasions HCCA offers the possibility of a better tumoural cleaning with the possibility of R0 resection. The incomplete removal of this tumoural thrombi in fact is correlated to an early recurrence and a worst postoperative survival (Skinner et al., 1989). Furthermore the hepatic, renal and splacnic damage from warm ischemia due to the Pringle's manoeuvre and/or aortic/mesenteric cross-clamping (usually necessary when CPB is used without cardio-circulatory arrest) is reduced when the HCCA is instead used (Chiappini et al., 2002, Davlouros et al., 2005). This permits its use

Tumour thrombus extension in the inferior vena cava (IVC) occurs in 4 % to 10% of patients with renal cell carcinoma (RCC) (Marshall et al., 1988). The cephalic extension of tumour

**1. Introduction** 

**2. Kidney** 

Minnesota (Gott, 2005).

Ariza et al., 1982; Kanda et al., 1991).

even in the setting of mild hepatic damage (Leo et al., 2010).

Wippermann, J., Albes, JM., Hartrumpf, M., Kaluza, M., Vollandt, R., Bruhin, R. & Wahlers, T. (2005). Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system. European Journal of Cardiothoracic Surgery. Vol. 28, No 1 (July 2005) pp. 127-32.
