Robotic Resection of a Primary Cardiac Sarcoma
Akbarshakh Akhmerov, Joshua Chung, Dominic Emerson, Alfredo Trento.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
OBJECTIVE: Robotic cardiac surgery appears safe and has been associated with lower mortality and complication rates. There is limited experience, however, with robotic resection of cardiac neoplasms. We report the first robotic excision of a left ventricular synovial sarcoma.
METHODS: A 19-year-old male was evaluated for chest pain, episodic lightheadedness, and systolic ejection murmur. He was found to have a 6.6 cm x 3.0 cm left ventricular mass, which was attached to the posteromedial papillary muscle and exhibited movement into the left ventricular outflow tract. General anesthesia and cardiopulmonary bypass via right femoral cannulation were utilized. Access into the thoracic cavity was gained via a right mini thoracotomy.
RESULTS: The tumor was noted to occupy most of the left ventricular cavity. The insertion of the tumor into the muscle was transected and the tumor was safely extracted out of the body. A small flail chordae tendinea was repaired, the atriotomy was closed, and the patient was weaned from cardiopulmonary bypass without inotropic support. Intraoperative echocardiogram demonstrated normal ventricular function, trace mitral regurgitation, and no evidence of residual tumor. The patient was extubated three hours later and, after an uneventful recovery, discharged on the fourth post-operative day. The final pathology revealed a poorly-differentiated, high-grade synovial sarcoma (stage pT1), with fluorescence in situ hybridization notable for SYT gene rearrangement. The patient subsequently underwent adjuvant chemotherapy.
CONCLUSIONS: There is limited experience with robotic resection of cardiac neoplasms. We report the first robotic excision of a primary synovial sarcoma, which appears safe and effective.
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