Resection and reconstruction of suprahepatic IVC and right atrium for invasive intrahepatic cholangiocarcinoma

Left hepatectomy with suprahepatic inferior vena cava resection and reconstruction under veno-arterial extracorporeal membrane oxygenation for intrahepatic cholangiocarcinoma: a case report

“…For such complicated reconstruction of the suprahepatic IVC and HV-confluence, THVE, V-V bypass, and/or cardiopulmonary bypass are important in order to maintain systemic blood pressure [ 2 , 3 ]. Furthermore, open heart surgery in order to suture between the right atrium and IVC is required [ 2 , 5 ]. Azoulay et al reported that patients should be selected carefully because of high mortality and morbidity rates; a 90-day mortality rate of 20% and morbidity rate of 70%, in 77 patients who underwent liver resection using THVE, V-V bypass, and in situ hypothermic portal perfusion [ 2 ].…”

“…Adequate reconstruction time and safe bypass are, therefore, required for complicated reconstruction of the suprahepatic IVC. Whang et al reported a case of ICC with invasion to the suprahepatic IVC treated with left hepatectomy and suprahepatic IVC resection under cardiopulmonary bypass (CPB) [ 5 ]. They concluded that the use of CPB was effective and that a team approach between HBP and cardiothoracic surgeons was important [ 5 ].…”

“…Whang et al reported a case of ICC with invasion to the suprahepatic IVC treated with left hepatectomy and suprahepatic IVC resection under cardiopulmonary bypass (CPB) [ 5 ]. They concluded that the use of CPB was effective and that a team approach between HBP and cardiothoracic surgeons was important [ 5 ]. Recently, the usefulness of V-A ECMO for not only cardiogenic shock patients, but also severe COVID-19 patients have been known.…”

“…4 After clamping the IVC diagonally and preserving the root of the RHV (arrowhead), the suprahepatic IVC was resected and reconstructed with a ringed extended polytetrafluoroethylene tube graft (20 mm) (a-d). No congestion in the right liver was seen; therefore, there was no requirement for the Pringle maneuver or THVE (arrows: blood flow during V-A ECMO) important [5]. Recently, the usefulness of V-A ECMO for not only cardiogenic shock patients, but also severe COVID-19 patients have been known.…”