Right atrial surgery with unsnared inferior vena cava

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Congenital Heart Disease

Background:

• Standard right atrial procedures necessitate snaring venous cannulas to prevent air embolism.
• Complex congenital heart morphology and pericardial adhesions can complicate standard surgical approaches.

Purpose of the Study:

• To evaluate the feasibility and safety of performing right atrial procedures without inferior vena cava (IVC) cannulation.
• To determine if this modified technique facilitates surgical exposure and simplifies operative procedures.

Main Methods:

• Cardiopulmonary bypass was established using femoral vein cannulation for venous drainage in patients undergoing complex congenital or acquired heart disease surgery.
• The right atrium was opened without direct cannulation or snaring of the IVC.
• Patients were maintained on normothermia or mild hypothermia with a flow index of 3 L/min/m(2).

Main Results:

• The modified technique allowed for right atrial opening without compromising venous drainage or causing air locks in the venous line.
• Enhanced surgical exposure and facilitated operative technique were observed.
• No negative consequences were reported in patients undergoing this approach.

Conclusions:

• Right atrial surgery on cardiopulmonary bypass without direct cannulation and snaring of both the superior and inferior vena cava is feasible.
• This approach can be safely implemented for both congenital and acquired cardiac lesions, improving surgical exposure without flow reduction.