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

Objectives: 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. Methods: 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. Results: 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%. Conclusions: 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.