Caval Cross-Clamping, Piggyback and Veno-Venous Bypass
Liver transplantation has historically been associated with massive blood transfusion and major hemorrhage was considered routine. Surgical techniques have evolved in an attempt to reduce blood loss and reduce transfusion requirements. In this chapter we review the physiologic effects of caval cross-clamping and explore surgical options to safely establish hepatectomy and transplantation including piggyback technique and venovenous bypass (VVB).
The aim of caval cross-clamping is to eliminate hepatic outflow prior to hepatectomy. Traditionally two inferior vena cava (IVC) cross clamps are placed with one below the diaphragm and one above the renal veins. Resection of the recipient’s vena cava is achieved by dividing both the infra- and supra-hepatic vena cava. Transplantation of the donor organ therefore requires both supra and infra-hepatic caval anastomoses and complete caval occlusion occurs during the vast majority of the anhepatic phase.
KeywordsCaval clamp Bypass circuit Piggyback Blood flow Anhepatic phase Reperfusion
- 26.Gurusamy KS, Pamecha V, Davidson BR. Piggy-back graft for liver transplantation. Cochrane Database Syst Rev. 2011;1:CD008258.Google Scholar