Volodymyr Isaienko
National Medical Academy, Ukraine
Title: The tactics of optimal surgical treatment of heart myxomas, the experience of 818 operations
Biography
Biography: Volodymyr Isaienko
Abstract
Material & Methods: In the N M Amosov National Institute of Cardiovascular Surgery of the Academy of Medical Sciences of Ukraine for the period from 1.01.1969 to 1.01.2018. 916 interventions were performed in heart tumors. Heart myxomas were found in 818 (89.3%) cases, of which 718 (87.8%) are myxomas of the left atrium. The age of patients with myxomes was 3 to 78 years (on average 47.5±3.4 years). The embolic syndrome was detected in 44 (5.4%) cases with a heart myxomas, of which 35 (4.1%) patients were in the cerebral vessels. The most traditional access through the right atrium and the interatrial septum was used in 543 (75.6%) cases with a myxomas of the left atrium, tumor fragmentation was observed in 109 (20.1%) cases. At the same time, an important stage of the operation is an adequate dissection of the interatrial septum. Analysis of the attachment of the left atrial myxoma to the interatrial septum in 124 patients showed that 66 (53.2%) had the tumor base in its middle third. In 45 (36.3%) cases the place of tumor fixation is the lower third of the interatrial septum. And only in 13 (10.5%) patients the upper third of the septum was affected. This is the safest site of introduction through the interatrial septum, and for the subsequent visualization of the tumor's foundation, which became the basis of our methodology.
Results: In 91 of 93 patients, the use of the new technique allowed the safe detection and isolation of the leg of the myxoma. The frequency of fragmentation of the tumor upon its removal decreased to 2.2%. The need for emergency surgery is proved, which reduces the threat of hospital preoperative mortality. Over the past 17 years, 455 operations have been performed without fatalities. Survival in the period up to 20 years was 79.7%. Relapses of myxogma were found in 16 (2.1%) patients in the period from 2 to 12 years after the initial operation.
Conclusions: With the most frequent localization of the myxoma in the left atrium, it is expedient to eliminate the myxoma by accessing the right atrium and the interatrial septum with an improved method of manipulation on it, with the subsequent possibility of switching to alternate atrial access to prevent fragmentation of the tumor.