Autogenous pericardial angioplasty for thymic malignancies: a narrative review

Abstract

Locally advanced thymic tumor usually invades adjacent great vessels, while the optimal treatment strategy for vessels resection and prosthetic replacement is still in controversial. We hereby present our series of patients undergoing autologous pericardial angioplasty for thymic malignancies. For invasive thymic tumors involving the superior vena cava (SVC), the replacement vessel was prepared by autologous pericardium and placed between the right atrium and distal left innominate vein stump to establish a SVC bypass. Then, the distal right innominate vein and proximal SVC were blocked, and the thymic tumor and involved vessel were completely resected, followed by SVC reconstruction using pericardium. We retrospectively analyzed the clinical characteristics and short-term outcomes of six related patients with autologous pericardial angioplasty. Due to the homologous advantages of autologous pericardial transplantation, those patients didn't need to receive anticoagulant therapy during the perioperative period, so as to avoid the occurrence of hemorrhage, embolism and other graft-related complications. There were no postoperative long-term thoracic drainage (>7 days), anastomotic bleeding, reconstructed vascular stenosis, embolism or even secondary thoracotomy and other related complications occurred in this case series. The application of autologous pericardium for the replacement of mediastinal great vessels in the surgery of locally advanced thymoma is a safe and effective technique. Compared with former artificial materials, such as polytetrafluoroethylene synthetic prosthesis, autologous pericardial transplantation avoids the occurrence of high risk graft-related complications such as postoperative hemorrhage and vascular stenosis, and its clinical application prospect is worth expecting.

Keywords: Thymic tumor; angioplasty; autologous pericardial transplantation; prognosis; superior vena cava (SVC).

Figure 1

Perioperative imaging of thymic tumor. (A) Dynamic enhanced CT scan shows tumor involved the left innominate vein; (B) thymic malignancies invade superior vena cava, with morphological changes in the adjacent mediastinal great vessels.

Figure 2

Intra-operative view. (A) Spreading the sternum and exploring the thymic tumor location, infiltrating situation of the adjacent organs; (B) the autologous pericardium was used to make an artificial great vessel conduit; (C) the left innominate vein-right atrium by-pass was built by autologous pericardial conduit, which sutured with 5-0 Polypropylene; (D) the thymic tumor and infiltrated vessels were radically resectred after blocking the related vessels; (E) the autologous pericardium was used to reconstruct the SVC lateral wall by 5-0 Polypropylene; (F) checking the anastomotic stenosis and anastomotic fistula after vascular graft reconstruction.

Figure 3

Postoperative imaging of autogenous pericardial angioplasty. (A) The enhanced CT-scan showed that the right innominate vein and superior vena cava were unobstructed (red arrow); (B) autologous pericardial by-pass conduit was applied between the left innominate vein and right atrium, without stenosis and thrombus formation (green arrow).