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Minimally invasive approaches to primary cardiac tumors: a systematic review and meta-analysis.
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  • Marco Moscarelli,
  • Mohamed Rahouma,
  • Giuseppe Nasso,
  • Nicola Di Bari,
  • Giuseppe Speziale,
  • Francesco Bartolomucci,
  • Martino Pepe,
  • Khalil Fattouch,
  • Christopher Lau,
  • Mario Gaudino
Marco Moscarelli
GVM Care and Research
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Mohamed Rahouma
New York Presbyterian Hospital Weill Cornell Medicine
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Giuseppe Nasso
GVM Care & Research
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Nicola Di Bari
GVM Care and Research
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Giuseppe Speziale
GVM Care and Research
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Francesco Bartolomucci
GVM Care & Research
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Martino Pepe
GVM Care & Research
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Khalil Fattouch
GVM Care and Research
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Christopher Lau
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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Mario Gaudino
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
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Abstract

Objective: Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification. Methods: A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intra- and post-operative outcomes; tumor size was also considered. Results: There were no significant between-group differences in terms of late mortality (incidence rate ratio (IRR): MI vs. MS, 0.98 [95% CI: 0.25¬–3.82], p = 0.98). Few relapses and redo surgery were observed in both groups (IRR: 1.13[0.26-4.88], p=0.87);( IRR: 1.92 [95% CI: 0.39-9.53], p=0.42); MI was associated to prolonged operation time yet with no effects on clinical outcomes. Tumor size did not significantly differ between groups. Conclusions: Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.

Peer review status:UNDER REVIEW

14 Oct 2020Submitted to Journal of Cardiac Surgery
16 Oct 2020Assigned to Editor
16 Oct 2020Submission Checks Completed
16 Oct 2020Reviewer(s) Assigned