Minimally invasive and robotic-assisted excision of intracardiac masses: a single-center retrospective study

Minimally invasive techniques for intracardiac mass excision have become more popular as alternatives to traditional sternotomy, offering potential advantages in terms of recovery and complication risk. However, evidence regarding their effectiveness and safety remains limited, especially for larger or more complex masses.

This retrospective study analyzed 26 patients who underwent minimally invasive intracardiac mass excision at Gulhane Training and Research Hospital between April 2015 and December 2023. Right minithoracotomy was performed in nine patients, and robot-assisted surgery was performed in 17 patients. Preoperative, intraoperative, and postoperative data were reviewed, with descriptive statistics used to summarize outcomes.

The cohort included a variety of benign and malignant cardiac masses. A patient required concurrent mitral valve replacement, and another needed additional mitral valve replacement and tricuspid valve repair. The largest excised mass measured 85 mm by 35 mm. One patient in the right minithoracotomy subgroup experienced intraoperative hemorrhage from the posterior wall of the left atrium and was converted to sternotomy for bleeding control. There is one in-hospital mortality from severe acute respiratory syndrome coronavirus 2 pneumonia; no late mortalities or reoperations occurred during a maximum follow-up of 104 months. The cardiopulmonary bypass times were 115.4 ± 70.8, 114.6 ± 44.9 min, and the cross-clamp times were 75.4 ± 38.8, 67.8 ± 43.6 min for the right minithoracotomy and robot-assisted subgroups, respectively.

Minimally invasive and robotic-assisted techniques for intracardiac mass excision may be safe and effective in select patients, offering outcomes similar to those of traditional surgery, with potential benefits in recovery. Careful preoperative assessment remains essential, especially for large or complex masses.