Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: The least invasive approach

Papillary fibroelastomas (PFEs) are a rare subtype of benign primary cardiac tumors, which are most commonly found on the aortic valve (AV). They have the potential to cause severe adverse clinical consequences, thus prompting surgical excision in the majority of cases. In this article, we report on a series of 5 PFEs resected from the AV using a robotic-assisted sternal-sparing approach, and review of the literature on this approach. To our knowledge, this is the largest reported series of robotic-assisted sternal-sparing AV-PFE resections.

From May 2016 until November 2018, 5 patients at our institution underwent removal of a papillary fibroelastoma from the aortic valve using a totally endoscopic robotic-assisted approach. After obtaining institutional IRB approval, we retrospectively reviewed their data for this report. We additionally contacted the patients to acquire a last clinical follow up for this study. Results In this series of 5 patients who underwent robotic totally endoscopic excision of AV PFE, all patients had successful removal of their tumor with no significant morbidity or mortality. All 5 patients were seen at a 30-day follow-up office visit, at which time they had recovered from surgery and were back to full activity. At a mean of 24 months all patients were doing well and free of symptoms with no evidence of tumor recurrence on repeat echo evaluation.

This is a series of 5 patients with AV-associated PFEs who underwent robotic totally-endoscopic excision without rib-spreading or conversion to sternotomy. This report demonstrated the successful application of robotic-assisted technology in aortic valve pathology. All PFEs were successfully removed without valve repair or replacement. We were able to offer a safe, curative, minimally-invasive surgical excision option for this group of patients.

Our patients in this cohort demonstrated the well-established benefits of robotic sternal-sparing cardiac surgery, including excellent intra and postoperative outcomes and accelerated recovery.