Replacement of the superior vena cava by the bovine pericardium conduit: Sustained patency without long-term anticoagulation.

Abstract

Direct infiltration of the superior vena cava by thoracic malignancies often requires en bloc resection and vascular reconstruction. Synthetic grafts such as polytetrafluoroethylene are associated with thrombosis and long-term anticoagulation. We present a large experience with bovine pericardium conduits for superior vena cava replacement, focusing on durable patency without long-term anticoagulation. Between 2003 and 2024, 61 patients with superior vena cava infiltration underwent replacement with a bovine pericardium conduit. Indications included lung cancer (40 cases) and thymic tumors (21 cases). Vascular reconstruction was performed using crossclamping without shunt. Postoperative follow-up included regular imaging studies (computed tomography and magnetic resonance imaging) to assess conduit patency and clinical outcomes. All patients achieved complete R0 resection. No long-term anticoagulation therapy was required postoperatively. Follow-up imaging confirmed long-term conduit patency in all surviving patients over 1 to 5 years, except 1 patient with jugular vein thrombosis secondary to a port-a-cath. The 30-day mortality rate was 6.5% (4 patients), with no deaths due to vascular complications. Major complications occurred in 9.8% of cases. For thymic tumors, the 5-year survival was 53.7%, whereas for lung cancer, it was 38.8%. Bovine pericardium conduits offer a safe and effective option for superior vena cava replacement, providing excellent prolonged patency without long-term anticoagulation. This biological material reduces the risks associated with synthetic grafts, representing a valuable alternative in complex vascular reconstructions. Broader adoption could significantly improve outcomes for patients undergoing superior vena cava replacement.