Original Article

Hepatic Resection Using Cardiopulmonary Bypass and Total Circulatory Arrest

Department of General Pediatric Surgery and the Division of Cardiovascular and Thoracic Surgery, The Children's Hospital, Denver, CO

^* Direct communications to: Dan R. Hydrick, C.C.P., PSICOR, Inc., 810 East Grand River, Brighton, MI 48116

Abstract

Hepatoblastomas are the third most common malignant intra-abdominal tumor and are universally fatal without resection. Resections of these tumors are often difficult due to their size. Chemotherapy is frequently used to reduce the size of the tumor and allow resection. Hepatic resection is often complicated with excessive bleeding and with an attendant mortality of 10 to 30%.

Cardiopulmonary bypass with total circulatory arrest was used on three patients for hepatic resection. The extracorporeal circuit consisted of a membrane oxygenator and a pulsatile flow pump. Pulsatile flow was utilized for its advantageous effects on cooling and rewarming times. An average time of 13 minutes was needed to cool the patient to a rectal temperature of 17°C. Upon reaching this temperature, systemic circulation was stopped and the patient was exsanguinated into the extracorporeal circuit. During circulatory arrest, tumor resection was performed. Circulatory arrest time averaged 37 minutes. After resection was completed, the patients were rewarmed to 37°C with an average time of 27 minutes and were gradually weaned from cardiopulmonary bypass.

This technique allows tumor resection in a bloodless environment and free retraction without fear of diminished circulation. Also, blood usage is minimal and blood conservation can be optimized.