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Ranjit P. Deshpande
Filip Casselman
Ihsan Bakir
Francis Wellens
Raphael De Geest
Ivan Degrieck
Frank Van Praet
Hugo Vanermen
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Ann Thorac Surg 2007;83:2142-2146
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Endoscopic Cardiac Tumor Resection

Ranjit P. Deshpande, FRCS(C-Th), Filip Casselman, MD, PhD*, Ihsan Bakir, MD, Guy Cammu, MD, Francis Wellens, MD, Raphael De Geest, MD, Ivan Degrieck, MD, Frank Van Praet, MD, Yvette Vermeulen, MS, Hugo Vanermen, MD

Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium

Accepted for publication January 29, 2007.

* Address correspondence to Dr Casselman, Department of Cardiovascular & Thoracic Surgery, OLV Clinic, 164 Moorselbaan, Aalst, 9300 Belgium. (Email: filip.casselman{at}olvz-aalst.be).

Background: The purpose of this study is to report our 9 years’ experience with endoscopic cardiac tumor resection using the port access approach.

Methods: 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.

Results: 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.

Conclusions: Endoscopic cardiac tumor resection is feasible and a valid oncologic approach with an attractive cosmetic advantage over median sternotomy.






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Copyright © 2007 by The Society of Thoracic Surgeons.