Endoscopic cardiac tumor resection

OLV Ziekenhuis Aalst, Alost, Flemish, Belgium
The Annals of thoracic surgery (Impact Factor: 3.85). 07/2007; 83(6):2142-6. DOI: 10.1016/j.athoracsur.2007.01.064
Source: PubMed


The purpose of this study is to report our 9 years' experience with endoscopic cardiac tumor resection using the port access approach.
From March 1997 to December 2005, 27 patients (mean age, 56.2 +/- 16.9 years; 70% female) underwent endoscopic cardiac tumor resection using endocardiopulmonary bypass and endoaortic-balloon clamp technique. Nineteen (70%) patients presented in New York Heart Association class I, 4 patients presented with embolic stroke, and 4 patients presented with atrial arrhythmias. All patients underwent echocardiography on admission, intraoperatively, at discharge, and at follow-up evaluation. Eight patients additionally required mitral valve replacement (n = 1), tricuspid valve replacement (n = 1), mitral valve repair (n = 2), mini-maze (n = 1), and closure of patent foramen ovale (n = 3). Mean follow-up was 3.4 +/- 2.7 years.
Mean endoaortic-balloon clamp and endocardiopulmonary bypass times were 68.8 +/- 30.8 minutes and 112.2 +/- 41.5 minutes, respectively. There were no conversions to sternotomy. Tumors resected were classified as left atrial myxoma (n = 20), right atrial myxoma (n = 3), lipoma (n = 1), intravenous leiomyoma involving the inferior vena cava and the tricuspid valve (n = 1), plexiform tumor of the sinoatrial node (n = 1), and papillary fibroelastoma of aortic valve noncoronary cusp (n = 1). There were no hospital deaths. Mean intensive care unit and hospital stays were 1.4 +/- 1.1 days and 7.3 +/- 3.4 days, respectively. Postoperative complications were evolving stroke (n = 1), re-exploration for bleeding (n = 1), and myocardial ischemia requiring stenting (n = 1). Follow-up failed to demonstrate residual or recurrent tumor. One patient had a small residual atrial septal defect. Ninety-two percent of patients appreciated the cosmetic result and fast recovery.
Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy.

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    • "Even the right heart can be resected almost completely and reconstructed using Fontan circulation [87]. In the literature, there is also a case of total resection of the left atrium and its orthotopic allograft transplantation due to leiomyosarcoma [88]. On the other hand, the analysis undertaken by Vitovskiĭ showed that breadth of the operation has no significant effect on the clinical status of patients in the immediate period after surgery [89]. "
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