Minimally invasive versus standard approach for excision of atrial masses

Abstract

Background: Minimally invasive cardiac surgical procedures have become ubiquitous over the past decade. In many cases, these techniques have been associated with decreased morbidity, shorter length of stay, decreased pain, faster recovery, and superior cosmetic results. The purpose of this study was to compare outcomes using a minimally invasive (mini-thoracotomy) versus standard (sternotomy) approach to the surgical resection of atrial masses.

Methods: Analysis was based on 34 consecutive patients who underwent atrial mass resection at the New York-Presbyterian Hospital/Columbia Presbyterian Medical Center in New York, NY. The reference (REF) group included 18 patients who underwent excision of an atrial mass via a standard approach (sternotomy). The minimally invasive (MI) group included 16 patients who underwent excision of an atrial mass via a mini-thoracotomy.

Results: There were no statistically significant differences between the REF and MI groups based on demographic or preoperative characteristics. Tissue diagnosis of the masses resected included myxoma (n = 24), fibroblastoma (n = 3), B-cell lymphoma (n = 1), and other benign masses (n = 6). Cardiopulmonary bypass (70.5 versus 76.5 minutes; P = .57) and aortic cross-clamp times (32.7 versus 47.3 minutes; P = .14) did not differ significantly between the REF and MI groups, nor did intraoperative transfusion of packed red blood cells (0.35 versus 0.38 units; P = .93). As assessed by intraoperative trans-esophageal echocardiogram, there were no moderate to severe valvular abnormalities observed following chest closure. Intensive care unit length of stay (46.1 versus 26.2 hours; P = .15), overall hospital length of stay (6.39 versus 5.06 days; P= .18), and time to extubation (0.78 versus 0.44 days; P = .44) all trended toward shorter duration in the MI group compared with the REF group-although none of these differences achieved statistical significance. Postoperative transthoracic echocardiograms were obtained in 14 of 34 (41.2%) patients; none revealed any new or significant abnormalities. All patients survived to hospital discharge; one patient in the REF group expired during the follow-up period. Among the 34 patients, 26 patients (76.4%) were at least 2 years postoperative from their resection; 25 of the 26 (96.1%) were alive at 2-year follow-up, and the remaining 8 were alive at 1-year follow-up. All patients were free of recurrence at last follow-up. CONCLUSIONS. Minimally invasive atrial mass excisions can be accomplished reliably without compromising complete tumor resection and without significant increases in operative times or serious adverse events. In addition, measures of recovery time in this study suggest faster recovery among the MI group, which is consistent with the proposed advantages by proponents of minimally invasive surgery.