Minimally Invasive Surgery for Cardiac Myxomas using an Upper Hemi-Sternotomy and Biatrial Septal Approach

Nordstrand, Indra A.J.; Tam, Robert

doi:10.1016/j.hlc.2005.03.022

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…For patients undergoing excision of cardiac masses through a partial hemi-sternotomy, there are limited data, with 3 case series being published [3,11,12]. The study by Ravikumar et al…”

Section: Partial Upper Hemi-sternotomy Approachmentioning

confidence: 99%

“…Hsu et al [11] reported 4 patients with papillary fibroelastomas who had uncomplicated resection via a partial sternotomy. On the other hand, Nordstrand and Tam [12] reported 2 patients who had a left atrial myxoma removed through a partial upper hemi-sternotomy, and reported a prolonged hospital length of stay secondary to arrhythmias and pulmonary complications.…”

Section: Partial Upper Hemi-sternotomy Approachmentioning

confidence: 99%

See 1 more Smart Citation

Is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy?

Pineda¹,

Santana²,

Cortés-Bergoderi³

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy?' A total of 50 papers were found using the reported search, of which, 11 represented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 11 papers were retrospective studies, from which 4 were case-control studies comparing the minimally invasive approach with conventional full sternotomy, and 7 were case series. There were two minimally invasive techniques used, a right mini-thoracotomy and a partial hemi-sternotomy, the former being the most commonly used. The resection of benign cardiac masses is a low-risk procedure, with no mortality or conversions to full sternotomy reported. From the 4 case-control studies, cross-clamp time was similar in both groups, and only one report found a prolonged perfusion time with the minimally invasive approach. The incidence of major postoperative complications, including bleeding requiring reoperation (average from case-control studies: 0-4.5 vs 0-5.8%), renal failure (0 vs 0-10%) and prolonged ventilation (6-13 vs 11-19%), for the two approaches was similar. The incidence of postoperative stroke was better for the minimally invasive approach in one study (0 vs 14%, P = 0.023). The main advantages of this technique are shorter intensive care unit (26-31 vs 46-60 h) and hospital stay (3.6-5.2 vs 6.2-7.4 days), the minimally invasive approach being significantly better in one and three reports, respectively. We conclude that minimally invasive resection of a benign cardiac mass using a right mini-thoracotomy approach can be performed with an operative morbidity and mortality at least similar to the standard full sternotomy approach. The information currently available for the minimally invasive approach for the resection of benign cardiac masses is limited and based only on retrospective studies and, therefore, prospective studies are required to confirm the potential benefits of minimally invasive surgery.

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“…For patients undergoing excision of cardiac masses through a partial hemi-sternotomy, there are limited data, with 3 case series being published [3,11,12]. The study by Ravikumar et al…”

Section: Partial Upper Hemi-sternotomy Approachmentioning

confidence: 99%

Section: Partial Upper Hemi-sternotomy Approachmentioning

confidence: 99%

Is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy?

Pineda¹,

Santana²,

Cortés-Bergoderi³

et al. 2013

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…In our study, the comprehensive postoperative outcomes were satisfactory. The CPB time and cardiac ischemic time were acceptable compared to the outcomes of other surgical approaches [12,13]. In most studies on minimally invasive approaches for myxoma resection, the median sternot-omy conversion rate has been reported to be 0% [6,8,9].…”

Section: Discussionmentioning

confidence: 91%

Surgical Outcomes of Cardiac Myxoma Resection Through Right Mini-Thoracotomy

Shin

Lee

et al. 2022

J Chest Surg

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This paper was presented at the 52nd Fall Meeting of the Korean Society for Thoracic and Cardiovascular Surgery.Background: With recent advances in cardiac surgery through minimal access, mini-thoracotomy has emerged as an excellent alternative for cardiac myxoma resection. This study analyzed the surgical results of this approach, focusing on postoperative cerebral embolism and tumor recurrence. Methods: We retrospectively reviewed 64 patients (mean age, 56.0±12.1 years; 40 women) who underwent myxoma resection through mini-thoracotomy from October 2008 to July 2020. We conducted femoral cannulation and antegrade cardioplegic arrest in all patients. Patient characteristics and perioperative data, including brain diffusion-weighted magnetic resonance imaging (DWI) findings, were collected. Medium-term echocardiographic follow-up was performed. Results: Thirteen patients (20.3%) had a history of preoperative stroke, and 7 (11.7%) had dyspnea with New York Heart Association functional class III or IV. Sixty-one cases (95.3%) had myxomas in the left atrium. The mean cardiopulmonary bypass and cardiac ischemic times were 69.0±28.6 and 34.1±15.0 minutes, respectively. Sternotomy conversion was not performed in any case, and 50 patients (78.1%) were extubated in the operating room. No early mortality or postoperative clinical stroke occurred. Postoperative DWI was performed in 32 (53%) patients, and 7 (22%) showed silent cerebral embolisms. One patient underwent reoperation for tumor recurrence during the study period; in that patient, a genetic study confirmed the Carney complex. Conclusion: Mini-thoracotomy for cardiac myxoma resection showed acceptable clinical and neurological outcomes. In the medium-term echocardiographic follow-up, reliable resection was proven, with few recurrences. This approach is a promising alternative for cardiac myxoma resection.

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“…20 This evidence included a reduction in the need for reoperation for bleeding, a tendency toward shorter hospital stays, and an equivalent perioperative mortality. 20 Many institutions began to use the upper 3 or the j-shaped ministernotomy 21 as early as 1998 after the first report of the minimally invasive resection of a cardiac myxoma using a right parasternal approach or submammary incision. 6 A comprehensive program of MICS has been developed at our institution since 2014 and is presently the most employed technique for atrioventricular valvular procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival

Praet

Kofler

Wilkens

et al. 2023

Innovations�(Phila)

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Objective: Evidence determining the optimal treatment for cardiac tumors is rare. We report our midterm clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral minithoracotomy (RLMT). Methods: From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation, and/or patent foramen ovale closure surgery were included. Follow-up was performed using standardized questionnaires (mean: 1,041 ± 666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients. Results: Successful surgical resection was achieved in all patients. Mean cardiopulmonary bypass and cross-clamping times were 75 ± 36 and 41 ± 22 min, respectively. The most common tumor location was the left atrium ( n = 42, 82.4%). Mean ventilation time was 12.74 ± 17.23 h, intensive care unit stay ranged from 1 to 1.9 days (median: 1 day). Nineteen patients (37.3%) received concomitant surgery. Histopathological analysis showed 38 myxoma (74.5%), 9 papillary fibroelastoma (17.6%), and 4 thrombus (7.8%). Thirty-day mortality was observed in 1 case (2%). One patient (2%) suffered a stroke postoperatively. No patient had a relapse of cardiac tumor. Three patients (9.7%) showed arterial embolization during follow-up. Thirteen follow-up patients (25.5%) were in New York Heart Association class ≤II. Overall survival was 90.2% at 2 years. Conclusions: A minimally invasive approach for benign atrial tumor resection is effective, safe, and reproducible. Of the atrial tumors, 74.5% were myxoma and 82% were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.

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Minimally Invasive Surgery for Cardiac Myxomas using an Upper Hemi-Sternotomy and Biatrial Septal Approach

Cited by 6 publications

References 13 publications

Is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy?

Is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy?

Surgical Outcomes of Cardiac Myxoma Resection Through Right Mini-Thoracotomy

Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival

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