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Ann Thorac Surg 2007;83:2142-2146
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Endoscopic Cardiac Tumor Resection

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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