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

Abstract

Introduction: 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.Materials and Methods: 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.Discussion: 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. Conclusion: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. K E Y W O R D S cardiac fibroelastoma, robotic, valve repair/replacement

Robotic resection of an aortic valve fibroelastoma using a right lateral approach

“…We consider resection of aortic tumors an excellent indication for robotic surgery, taking advantage of the visualization and precision offered by this technology. Only three cases of robotic resection of aortic fibroelastomas have been published 4–6 . We believe the approach routinely used for robotic mitral surgery provides excellent exposure and instrument clearance to work in the aortic valve, while ensuring an exceptional functional and cosmetic result.…”

“…Only three cases of robotic resection of aortic fibroelastomas have been published. [4][5][6] We believe the approach routinely used for robotic mitral surgery provides excellent exposure and instrument clearance to work in the aortic valve, while ensuring an exceptional functional and cosmetic result. This approach may also facilitate the learning curve for rAVS if performed by teams already proficient in robotic mitral surgery.…”

Giant and multiple cardiac papillary fibroelastomas masquerading as acute cerebrovascular events

“…Surgical resection has traditionally been performed using cardiopulmonary bypass via median sternotomy. Recently, minimal invasive techniques have been employed to that goal, including thoracoscopic [ 23 , 24 ] or robotic access [ 25 ].…”

A Shifting Paradigm in Robotic Heart Surgery: From Single-Procedure Approach to Establishing a Robotic Heart Center of Excellence

“…We have used a robotic totally endoscopic approach for AVR using both stentless and sutureless valves, 38 as well as for excision of fibroelastomas of the aortic leaflets. 48 We believe that the idea of using a robotic approach to treat some aortic valve morphologies with neocuspidization and leaflet repair has a lot of potential.…”