Surgical Therapy
There are no consensus guidelines regarding PFE treatment. Due to tumor
embolization risk, many groups advocate urgent resection in
asymptomatic, low risk patients with left sided
lesions.8-10, 24-27 It is generally agreed upon that
symptomatic patients should be offered surgery. Surgical approaches to
PFE are driven by tumor location and additional concomitant surgical
procedures that may be required. For solitary tumors without valvular
dysfunction, simple excision is the most common resection
technique.26 Excision and valve repair/replacement has
also been described with good results.
Median sternotomy historically was the most popular surgical exposure.
Increasing use of minimally invasive cardiac surgery however has led to
tumor removal using mini thoracotomy/Heart Port access techniques (Table
1). Intracavitary ventricular-based tumors not readily visible through
surgical incisions have been resected using cardioscopy assistance
(Table 2). 16-26 Cardioscopy must be performed
carefully to avoid injuring the intrinsic structure of the heart.
Tumor resection principles include: complete tumor removal with
preservation of cardiac structure. Cardiopulmonary bypass support is
required. Procedures have been performed with and without
electromechanical arrest. Recurrence rate following surgical resection
is between 0 and 4%.10, 11, 28 Recurrent disease
management is driven by tumor size, symptoms, and patient performance
status.