Temporary aorto-aortal bypass used during extended pneumonectomy for lung cancer

Involvement of the aortic arch, or the descending aorta, is not uncommon in left-sided lung tumours. The direct invasion of the aortic wall is generally considered a contraindication in lung resection. However, there are a limited number of reports of full thickness resections of the aorta during lung cancer surgery. They may be accomplished as a partial resection using a patch, or as a local tubular resection with reconstruction by a graft. In order to prevent ischaemia of the spinal cord, a cardiopulmonary bypass is usually recommended. The authors present a case report of a full thickness tubular resection of the descending aorta during pneumonectomy for centrally located lung carcinoma. The direct invasion to the descending aorta was only confirmed intraoperatively. After tumour dissection, two aortal cannulas were inserted into the aorta: the first one into the aortic arch over the left subclavian artery, the other one into the descending aorta over the diaphragm. They were then bypassed without a pump. The descending aorta was cross-clamped and replaced by a Dacron graft. There were no early complications : the patient has already survived two years after surgery with no recurrence.