Cardiopulmonary bypass and cell-saver technique in combined oncologic and cardiovascular surgery.

The purpose of this study was to work out an adequate operative technique for patients with malignant tumors who also need open heart surgery or procedures on major blood vessels. We had 8 such patients. In 6 of them, a tumor (3 cases hypernephroid cancer and 3 cases retroperitoneal sarcoma) had grown through the inferior vena cava (IVC) up to the right atrium. Two patients had lung cancer together with severe coronary artery disease. All of these patients were operated on using a heart-lung machine (HLM) and cell saver (CS). In 6 patients the intravascular portion of the tumor was extracted as much as possible through a right atrium approach (in 3 cases a nephrectomy was performed). Two patients had a one-stage coronary artery bypass graft (CABG) and a lobectomy. All of the patients had uneventful postoperative periods and were alive when checked on 1 year after the procedures. During cytological investigation after each operation, tumor cells were found only on the internal surface of the HLM arterial filters with 20 microns holes. We suggest that special cardiovascular devices such as the HLM and CS might be used in borderline situations in oncology without increasing the risk of hematogenous tumor dissemination.

[Variants of procedures of artificial blood circulation and the proteinase activity of the blood]. / Varianty provedeniia iskusstvennogo krovoobrashcheniia i proteinaznaia aktivnost' plazmy krovi.

The use of a "Cell-Saver" technique prevented hyperproteolysis and deletion of proteinase inhibitors in the blood plasma of patients during cardiopulmonary bypass. The technique also improved the course of the postoperative period, decreased the incidence of lung complications and prevented effectively postoperative bleedings. A prognostic value of alpha 1-proteinase inhibitor to trypsin activity ratio in the blood plasma of patients subject of cardiopulmonary bypass surgery has been demonstrated.