This patient had a large renal cell carcinoma (left kidney) with extension into the inferior vena cava and extended to the right atrium where it expanded. In combination with the oncologist Prof Vijaykumar who is the Director of Kidwai Memorial Institute of Oncology we mobilized the renal tumor. I tried to push the tumor down via an atrial purse string but palpation showed it bigger than the caval orifice so on cardiopulmonary bypass using vacuum assisted venous drainage we removed the tumor.. You can see the excellent exposure at both ends with vacuum assist. I opened the right atrium with an SVC cannula and then under direct observation placed the IVC cannula into the cava under direct vision using the IVC cannula tip to manage the return from the lower half of the body and avoided circulatory arrest. I had a wire in the femoral vein for additional drainage if it was necessary but did not need it. You can see that even with no snares on the SVC/IVC and venotomy of the renal vein there is no flooding providing excellent exposure and avoiding circulatory arrest with its attendant issues. We palpated from both ends to confirm no adherence anywhere and divided the specimen and I retrieved the vascular component from above and the renal component was removed from below since there was no way to retrieve the specimen from the caval orifice.Patient was weaned off CPB and hemostasis was obtained. Patient has done well postop and Histopath is awaited.Click on the image to see a bigger image.
