Table 1:
Best evidence papers
| Author, date, Journal and country Surgical approach Study type (level of evidence) |
Patient group | Outcomes | Key results | Comments |
|---|---|---|---|---|
| Schilling et al. (2012), J Card Surg, USA [2] Robotic-assisted right mini-thoracotomy Case–control (level 4) |
Outcomes of 16 patients with atrial myxomas who underwent robotic-assisted resection were compared with those of 29 patients who had full sternotomy | In-hospital mortality Conversion to full sternotomy Bleeding requiring reoperation Postoperative renal failure Postoperative stroke Sternal wound infection Prolonged ventilation Blood products administered Perfusion time (mean ± SD) Cross-clamp time (mean ± SD) ICU length of stay (mean ± SD) Total hospital length of stay (mean ± SD) Tumour recurrence |
0/16 (0%) vs 0/29 (0%), P = NA None 0/16 (0%) vs 0/29 (0%), P = NA 0/16 (0%) vs 3/29 (10%), P = 0.54 0/16 (0%) vs 0/29 (0%), P = NA 0/16 (0%) vs 0/29 (0%), P = NA 1/16 (6%) vs 3/29 (11%), P = 1.0 2/16 (13%) vs 7/29 (26%), P = 0.30 91.3 ± 45.2 vs 96.8 ± 42.1 min, P = 0.68 49.4 ± 37.6 vs 52.1 ± 39.6 min, P = 0.82 30.9 ± 18.4 vs 47.7 ± 52.1 h, P = 0.15 3.6 ± 0.8 vs 6.2 ± 5.1 days, P = 0.05 No follow-up |
Retrospective nature of the study Comparison with conventional sternotomy Robotic-assisted excision of atrial myxomas had similar postoperative outcomes and shorter total hospital length of stay, when compared with standard median sternotomy |
| Panos et al. (2012), Ann Thorac Surg, Greece [3] Video-assisted right mini-thoracotomy Case series (level 4) |
10 patients underwent video-assisted minimally invasive resection of cardiac myxomas | In-hospital mortality Conversion to full sternotomy Postoperative complications PRBC's requirements Perfusion time (mean ± SD) Cross-clamp time (mean ± SD) ICU length of stay (mean ± SD) Tumour recurrence |
None None None None 30 ± 15 min 25 ± 12 min 0.9 ± 0.2 days None (2–28 months follow-up) |
Retrospective nature of the study No comparison with standard approach |
| Pineda et al. (2011), Ann Thorac Surg, USA [4] Right mini-thoracotomy Case–control (level 4) |
Outcomes of 22 patients with benign cardiac masses who underwent excision through a right mini-thoracotomy were compared with those of 17 patients who had full sternotomy approach | In-hospital mortality Conversion to full sternotomy Postoperative complications Prolonged ventilation (>24 h) Bleeding requiring reoperation Postoperative stroke Postoperative renal failure Perfusion time (median, IQR) Cross-clamp time (median, IQR) ICU length of stay (median, IQR) Total hospital length of stay (median, IQR) Tumour recurrence |
0/22 (0%) vs 0/17 (0%), P = 1.0 None 3/22 (14%) vs 4/17 (24%), P = 0.42 2/22 (9%) vs 2/17 (12%), P = 0.78 1/22 (4.5%) vs 1/17 (5.8%), P = 0.85 0/22 (0%) vs 0/17 (0%), P = 1.0 0/22 (0%) vs 1/17 (5.8%), P = 0.24 78 (55–88) vs 57 (33–70) min, P = 0.02 43 (30–64) vs 31 (23–47) min, P = 0.20 27 (24–47) vs 60 (48–79) h, P = 0.001 5 (4–6) vs 7 (6–8) days, P = 0.03 No follow-up |
Retrospective nature of the study Comparison with conventional sternotomy Excision of atrial myxomas through a right mini-thoracotomy had similar postoperative outcomes and shorter ICU and total hospital lengths of stay, when compared with standard median sternotomy |
| Iribarne et al. (2010), Ann Thorac Surg, USA [5] Right mini-thoracotomy or hemi-sternotomy Case–control (level 4) |
Outcomes of 38 patients with cardiac masses who underwent excision through minimally invasive approach were compared with those of 36 patients who had full sternotomy approach | In-hospital mortality Conversion to full sternotomy Prolonged ventilation (>24 h) Bleeding requiring reoperation Postoperative stroke Postoperative renal failure Perfusion time (mean ± SD) Cross-clamp time (mean ± SD) Total hospital length of stay (mean ± SD) 1-year mortality Tumour recurrence |
0/38 (0%) vs 0/36 (0%), P = 1.0 None 5/38 (13%) vs 7/36 (19%), P = 0.54 0/38 (0%) vs 1/36 (2.8%), P = 0.48 0/38 (0%) vs 5/36 (14%), P = 0.023 0/38 (0%) vs 0/36 (0%), P = 1.0 77.0 ± 4.4 vs 68.0 ± 4.4 min, P = 0.15 41.3 ± 4.1 vs 39.3 ± 3.5 min, P = 0.71 5.2 ± 0.6 vs 7.4 ± 0.9 days, P = 0.03 0/38 (0%) vs 1/36 (2.8%), P = 0.48 No information |
Retrospective nature of the study Comparison with conventional sternotomy Excision of atrial myxomas through a right mini-thoracotomy had similar postoperative outcomes and shorter hospital length of stay, when compared with standard median sternotomy Up to 1-year follow-up available |
| Vistarini et al. (2010), Interact Cardiovasc Thorac Surg, Italy [6] Right mini-thoracotomy Case series (level 4) |
Outcomes of 14 patients with a left atrial myxoma who underwent excision through a right mini-thoracotomy are presented | In-hospital mortality Conversion to full sternotomy Bleeding requiring reoperation Postoperative stroke Wound complications Perfusion time (mean ± SD) Cross-clamp time (mean ± SD) Total hospital length of stay Mean ICU length of stay 2-year mortality Tumour recurrence |
None None 1 (7%) 2 (14%) None 88 ± 57 min 49 ± 29 min Mean 8 days Mean 3 days 2 (14%) None (mean follow-up 24 months) |
Retrospective nature of the study No comparison with standard approach |
| Russo et al. (2007), Heart Surg Forum, USA [7] Right mini-thoracotomy Case–control (level 4) |
Outcomes of 16 patients with atrial masses who underwent excision through minimally invasive approach were compared with those of 18 patients who had full sternotomy approach | In-hospital mortality Conversion to full sternotomy PRBC units transfused Perfusion time (mean ± SD) Cross-clamp time (mean ± SD) ICU length of stay (mean) Total hospital length of stay (mean ± SD) 2-year mortality Tumour recurrence |
0/16 (0%) vs 0/18 (0%), P = 1.0 None Mean 0.38 vs 0.35, P = 0.93 76.5 ± 29.0 vs 70.5 ± 28.5 min, P = 0.57 47.3 ± 27.7 vs 32.7 ± 22.3 min, P = 0.14 26.2 vs 46.1 h, P = 0.15 5.1 ± 2.8 vs 6.4 ± 2.8 days, P = 0.18 0/18 (0%) vs 1/16 (5.6%), P = 0.34 None (2-year follow-up in 26/34 patients) |
Retrospective nature of the study Comparison with conventional sternotomy Excision of atrial masses through a right mini-thoracotomy had similar postoperative outcomes when compared with standard approach Up to 1-year follow-up available |
| Hsu et al. (2006), Interact CardioVasc Thorac Surg, USA [8] Upper hemi-sternotomy Case series (level 4) |
4 patients underwent excision through an upper hemi-sternotomy | In-hospital mortality Conversion to full sternotomy Postoperative complications Perfusion time Cross-clamp time Total hospital length of stay Tumour recurrence |
None None None Mean 66 min Mean 35 min Mean 4 days No follow-up |
Retrospective nature of the study No comparison with standard approach |
| Bossert et al. (2006), Interact CardioVasc Thorac Surg, Germany [9] Right mini-thoracotomy Case series (level 4) |
77 patients with primary cardiac tumours, including 19 patients with benign tumours who underwent right mini-thoracotomy | 30-day mortality Conversion to full sternotomy Perfusion time (median, IQR) Cross-clamp time (median, IQR) Tumour recurrence |
0/19 (0%) vs 2/58 (3.4%), P = 0.56 None 91 (50–124) min 54 (22–65) min None (mean follow-up 5.1 years) |
Retrospective nature of the study Limited comparison with conventional full sternotomy |
| Nordstrand et al. (2005), Heart Lung Circ, Australia [10] Upper hemi-sternotomy Case series (level 4) |
2 patients underwent removal of a left atrial myxoma through an upper hemi-sternotomy | In-hospital mortality Conversion to full sternotomy Perfusion time Cross-clamp time ICU length of stay Total hospital length of stay Tumour recurrence |
No deaths No conversions Mean 77 min Mean 36 min Mean 3.5 days Mean 11 days None (mean follow-up 3.1 months) |
Retrospective nature of the study No comparison with standard approach |
| Ravikumar et al. (2000), Ann Thorac Surg, India [11] Partial sternotomy or right mini-thoracotomy Case series (level 4) |
5 patients underwent removal of a cardiac tumour through a partial sternotomy or a right mini-thoracotomy | In-hospital mortality Conversion to full sternotomy Complications Perfusion time Cross-clamp time Total hospital length of stay Tumour recurrence |
No deaths No conversions Stroke 1/5 (20%) Mean 91 min Mean 59 min Mean 7.8 days None (follow-up not specified) |
Retrospective nature of the study No comparison with standard approach |
| Ko and Tam (1998), Ann Thorac Surg, Taiwan [12] Right mini-thoracotomy Case series (level 4) |
3 patients underwent removal of a left atrial myxoma through a right mini-thoracotomy | In-hospital mortality Conversion to full sternotomy Complications Perfusion time Cross-clamp time Total hospital length of stay Tumour recurrence |
No deaths No conversions None Mean 111 min Mean 58 min Mean 7.7 days (range: 5–12) None (mean follow-up 10.5 months) |
Retrospective nature of the study No comparison with standard approach |
ICU: intensive care unit; PRBC: packed red blood cells; SD: standard deviation: IQR: interquartile range (25–75); NA: not applicable.