Long-term outcomes with a minimally invasive approach for resection of cardiac masses

Background: Minimally invasive cardiac surgery has been used with increased frequency in all areas of cardiac surgery. The purpose of this study was to compare the effectiveness of a minimally invasive (MI) versus traditional sternotomy approach for the resection of cardiac masses.

Methods: From January 1, 2000 to December 31, 2007, 74 patients (36 traditional sternotomy, 38 MI) underwent surgery for isolated resection of a cardiac mass. Major outcomes of interest included cardiopulmonary bypass time, cross-clamp time, conversion to full median sternotomy, final pathologic diagnosis, tumor-free margins of specimen, length of stay, major in-hospital complications (stroke, renal failure, respiratory failure, reoperation, and infection), and survival. Mean follow-up time was 4.8 years.

Results: There was no significant difference in cardiopulmonary bypass time or cross-clamp time between groups. No MI cases required conversion to a full median sternotomy, and there was no evidence of new valvular insufficiency on postoperative transesophageal echocardiogram. There was also no difference between traditional sternotomy and MI groups with regard to margins of the resected specimen, nor was there a difference in the size of the resected specimen between groups. Length of stay was shorter in the MI group by 2.2 days (p = 0.044), and the proportion of strokes was also lower in the MI group (p = 0.023). There was no difference in morbidity or mortality between groups.

Conclusions: A minimally invasive approach for cardiac mass resections is equally safe and effective compared with the traditional sternotomy approach. Limited surgical exposure did not compromise tumor resection margins, and the MI approach was associated with reduced hospital length of stay.