Hepatic Venous Outflow Reconstruction Directly Into the Right Atrium.

Area of Science:

• Hepatobiliary surgery
• Transplant surgery
• Vascular reconstruction

Background:

• Living-donor liver transplantation for Budd-Chiari syndrome presents challenges due to the absence of vena cava in grafts and potential recipient vena cava thrombosis.
• Standard venous outflow reconstruction can be difficult or impossible in these cases.

Observation:

• A novel technique utilizing the right atrium for venous outflow reconstruction was applied in three patients.
• This approach bypasses the need for vena cava replacement or reconstruction.

Findings:

• All three patients survived with no vascular complications at a mean follow-up of 67 months.
• The surgical technique proved effective, with variations noted primarily in vena cava preservation.

Implications:

• Right atrial reconstruction offers a feasible and safe alternative for graft venous outflow in challenging living-donor liver transplant cases for Budd-Chiari syndrome.
• This method facilitates hepatectomy by allowing safe resection of the vena cava, simplifying the procedure in the presence of dense adhesions.