Atrial Myxoma: Totally Endoscopic Robotic Resection Of Benign Cardiac Tumours And Role Of Cryoablation
Jalal Bin Saeid, MD, FRCS, Alistair Marshall, MSc, Paul Modi, MD, FRCS.
Liverpool Heart and Chest Hospital NHS, Liverpool, United Kingdom.
Background:Myxomas are the most common benign cardiac tumour with a high risk of recurrence in case of incomplete resection. We present our experience managing left atrial myxoma using the robotic-assisted approach with the focus on the role of cryoablation to avoid the need for patch reconstruction of the atrial septum and to prevent local recurrence. Methods:A 64-year-old female patient with no previous thromboembolic events was diagnosed with a 22mm left atrial tumour with a narrow insertion on the inter-atrial septum (IAS). Her Body Mass Index (BMI) was 19.5, and her left ventricular function was good. There was no significant valvular pathology. Results:She underwent a minimally invasive robotic-assisted surgery to remove left atrial tumour. The left atrium was opened through Waterston's groove, and the myxoma resected in the subendocardial plane. The rest of the left atrium was inspected for any satellite lesions. An Argon cryoablation probe was folded in the shape of "U" to facilitate covering the base of the tumour. Two 2-minute cryoablations applications were performed to ablate the base and a 1cm margin around the resection site. The total bypass time was 118-minutes and ischaemic time of 55-minutes. Postoperative recovery was uneventful with less than 24 hours intensive care unit stay, and a total postoperative hospital stay of five days. The patient is free from recurrence at follow-up. Conclusion: Excision of left atrial myxoma can be performed safely using a robotic-assisted approach. Cryoablation is a simple strategy to facilitate a minimally invasive approach in cardiac myxomas to avoid the need for patching of the atrial septum and to prevent local recurrence.
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