Left Atrial Thrombectomy Under Cardiopulmonary Bypass Without Aortic Cross-Clamping Using Rapid Ventricular Overdrive...

BACKGROUND Aortic cross-clamping is usually required to clearly visualize the surgical field in mini-thoracotomy because cardiac surgery without aortic cross-clamping can be challenging. However, certain patients may require alternative strategies for cardiovascular surgeries. CASE REPORT We report the case of a 73-year-old woman with prior valve replacement who underwent left atrial thrombectomy under cardiopulmonary bypass without aortic cross-clamping using rapid ventricular overdrive pacing. She was referred to our hospital for an evaluation of elevated C-reactive protein levels. Computed tomography coronary angiography revealed a large non-mobile mass in the left atrium that did not decrease after anticoagulation therapy. A high degree of adhesion was observed around the aortic root, making median sternotomy and aortic cross-clamping hazardous. Thrombectomy during perfused ventricular fibrillation was an option but is associated with other potential complications such as coagulopathy, arrhythmia, hyperglycemia, and disordered electrolytes that could further increase the total risk. Therefore, rapid ventricular overdrive pacing was selected to achieve temporary circulatory arrest, combined with a mini-thoracotomy approach. Rapid ventricular overdrive pacing was successfully maintained throughout the thrombectomy, and the patient was easily weaned from cardiopulmonary bypass. She was extubated in the operating room at the end of the surgery. She recovered without complications and was discharged walking independently. CONCLUSIONS Rapid ventricular overdrive pacing to achieve temporary circulatory arrest during cardiovascular surgery may be a new therapeutic option in patients with high risks associated with reoperation.