title: Outcomes of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses.
abstract: BACKGROUND
  We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median sternotomy.
  
  
  METHODS
  We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median sternotomy.
  
  
  RESULTS
  Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p=0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p=0.02) for the minimally invasive group and the median sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p=0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p=0.03) for the minimally invasive and the median sternotomy group, respectively.
  
  
  CONCLUSIONS
  A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients.
authors.affiliation: Division of Cardiology, Columbia University at Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA.
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Carlos
authors.initials: C
authors.lastname: Zamora
authors.forename: Alexandre M
authors.initials: AM
authors.lastname: Benjo
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods*; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome