Cardiopulmonary bypass for extended resections

Some thoracic malignancies can involve or displace the great vessels or cardiac chambers. The use of cardiopulmonary bypass can be necessary in two clearly differentiated scenarios: the need to resect any infiltrated cardiac structure, usually left atrial wall, or prevention of massive bleeding because of the proximity of tumor to cardiac chambers or great vessels. The procedure must be carefully planned by a multidisciplinary team to choose the more appropriate approach and vascular access which better conform patient characteristics and consider all possible complications. It is also necessary to consider the risks of the procedure and the advantages and inconveniences of non-surgical therapy or palliative alternatives. Depending on the characteristics of the tumour, the surgical team can select a frontal approach through midsternotomy of distal cannulation through the groin or axilla. The three of them are described in the text and two personal cases are shown illustrating clinical situations in real practice.