Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
ISMICS 2006 Annual Meeting Poster Session: Session 3 - Innovative Techniques and Technologies I
Columbia University, New York, NY, USA
Proposed advantages of minimally-invasive cardiac surgery include decreased morbidity, decreased pain, faster recovery, shorter length of stay, and superior cosmetic results. This study compared outcomes using a minimally-invasive (mini-thoractomy) versus standard (sternotomy) approach to the surgical resection of atrial masses.
34 consecutive patients undergoing atrial mass resection at the New York-Presbyterian Hospital/Columbia in New York, via sternotomy (reference group, 18) (REF) or a mini-thoracotomy (minimally-invasive group, 16) (MI) were included in the study.
There were no statistically significant differences between the REF and MI groups based on demographic or preoperative characteristics including age (58.8 vs 52.9 years; p=0.33). Tissue diagnosis of the masses resected included myxoma (n=24), fibroblastoma (n=3), B-cell lymphoma (n=1), and other benign masses (n=6). CPB (70.5 vs 76.5 minutes; p=0.57) and aortic crossclamp times (32.7 vs 47.3 minutes; p=0.14) did not differ significantly between the groups, nor did interoperative transfusion of packed RBCs (0.35 vs 0.38 units; p=0.93), Intraoperative trans-esophageal echocardiography revealed no moderate-severe valvular abnormalities following chest closure. ICU stay (46.1 vs 26.2 hours; p=0.15), overall hospital length of stay (6.39 vs 5.06 days; p=0.18) and time to extubation (0.78 vs 0.44 days; p=0.44) all trended toward shorter duration in the MI group–though these differences did not achiev statistical significance. Postoperative trans-thoracic echocardiograms were obtained in 14 of 34 (41.2%) patients; none revealed any new or significant abnormalities. While 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.
Minimally invasive atrial mass excisions can be accomplished reliably without compromising complete tumor resection, significant increases in operative times, or increases in serious adverse events. In addition, this study suggests faster recovery among the MI group, consistent with the proposed advantages by proponents of minimally invasive surgery.