Cavoatrial tumor thrombus excision without circulatory arrest

Introduction. Traditional methods of cavoatrial thrombus excision use deep hypothermic circulatory arrest with significant associated morbidity and mortality. We describe a novel technique that avoids circulatory arrest, yet provides a bloodless field for tumor excision. Technical Considerations. A 59-year-old woman presented with a left renal mass and tumor thrombus with extension into the right atrium. After left radical nephrectomy, an aortic occlusion balloon was placed in the abdominal aorta at the level of the diaphragm, limiting flow in the inferior vena cava for tumor excision and maintaining both cerebral and spinal cord perfusion during cardiopulmonary bypass. Tumor excision was successfully performed using this technique with minimal postoperative morbidity in the patient described. She remained free of recurrence at 9 months of follow-up. Conclusions. Cavoatrial tumor thrombus excision can be successfully performed without deep hypothermic circulatory arrest.