What Is Heart Tumor Removal Surgery

Overview

Heart tumours are rare but manifest with various clinical presentations and often cause unexpected symptoms or sudden death. So it is important to remove these tumors with surgery. In other cases, surgery may not be possible, your healthcare provider or doctor may recommend alternative treatments or palliative care.

There are various non-specific symptoms related to heart tumors which make this surgical removal mandatory to improve life quality and expectancy. 

Surgical removal of heart tumours includes various methods like open heart surgery or minimally invasive surgery depending on the patient's condition and its spread. Here in this article, we will focus on various types of heart tumour removal surgeries, their indications, related complications and other alternative options to surgery. 

What is Heart Tumor removal surgery

Heart or cardiac tumour removal surgery is a complicated medical procedure that removes or repairs heart tumours. 

Depending on the type of tumour surgical procedure does vary to repair damage to your heart or one of its valves. Surgeons and physicians decide if you need heart removal surgery or not.¹

Before knowing more about heart tumour removal surgery it is important to know what is heart tumour, in the below paragraph we will see what is heart tumour in brief.

What is Heart Tumor

A heart tumour is a rare, abnormal tissue growth that develops in the heart. 

It is of two types:

1. Non-cancerous (benign) 

 2. Cancerous (malignant) 

Cardiac tumours are also classified as primary means originating within the heart itself or secondary means spreading from a primary tumour in a different part of the body.² 

Most primary heart tumours are benign. Primary heart tumours have no risk of metastasis (spreading), and they are not life-threatening as long as they’re removed. The primary heart tumors are majorly myxomas or papillary fibroelastomas. These are benign in growth and can affect heart valve function. Primary heart tumours can increase the risk of a blood clot which can travel through the bloodstream (embolism) or a stroke and need to be removed.¹

Secondary cardiac tumours are more frequent by 20-30 times than primary heart tumours and mostly occur in patients from other parts of the body with breast cancer, lung cancer, lymphoma, renal cell cancer, or melanoma.² 

Cancerous heart tumours or sarcomas are exclusively rare, and most often sarcomas are not treated with surgery.¹

Patients with heart tumors must proceed for surgery in a specialized center, under experienced physicians and surgeons. Surgery should be done for both malignant and benign tumours, especially for atrial myxoma, in which complications and embolisation are common.³

Who gets affected by heart tumours

Heart tumours can be seen at any age, depending on the form. Teratomas may occur while a fetus is still in the mother's womb (uterus). Various other types develop at the time of childhood or different stages of life. Myxomas are two to four times more common among newborn females than in newborn males. Sarcomas can be commonly seen in middle-aged adults at an average age of 44.⁴

 Indications for Heart Tumor Removal Surgery

One may need surgery to remove a heart tumour if the physician or cardiac surgeon believes the benefits of surgery outweigh the risks. The following are the indications for heart tumour removal surgery.¹

1. Causes non-specific symptoms like Chest discomfort, dizziness, fainting, fatigue, fever and chills, heart palpitations and failure, joint pain, loss of appetite, shortness of breath etc.⁴
2. Interferes with your heart function.
3. Raises your risk of complications like blood clots or a stroke.
4. Is growing quickly.¹

Preoperative procedure

Following are the diagnostic tests that need to be done and are advisable by the doctor before surgery.

1. Computed tomography (CT) scan.
2. Coronary angiogram.
3. Echocardiogram.
4. Magnetic resonance imaging (MRI) scan.¹

As the diagnosis of a heart tumour is confirmed, the patient should be treated at an integrative medical centre. The medical center or hospital should be experienced enough to treat different patients which includes adults, pediatric patients, transplantation and artificial heart implantation. It requires versatility to perform heart surgery and hence becomes challenging for heart surgeons.³

Along with the above procedures, your surgeon may ask you to make changes in your medication schedule if required, not to eat or drink anything before surgery, and to quit smoking to avoid complications.¹

Surgical techniques

Open heart surgery

Open heart surgery gives surgeons a direct and clearer view of your heart and also of the surrounding anatomy. 

Before the initiation of surgery anesthesia is given to make surgery painless.

It is done with a median sternotomy procedure that makes long and vertical incisions down the middle of the chest.

The cardiopulmonary bypass also called a heart-lung machine is connected which works as a natural heart and lung and allows surgeons to operate on a non-beating still heart.

The tumor is removed and if needed heart is reconstructed through valve repair or replacement depending on how the tumor damaged one's heart.¹

Minimally invasive approaches

1. Thoracoscopic Surgery

Anesthesia is given before this surgery and also cardiopulmonary bypass is used to make the procedure more effective.

In this procedure, the surgeon uses a small incision to access your heart and removes the tumour.

2. Robotic-Assisted Surgery

It is a type of minimally invasive surgery which is performed using an endoscope. In Robotic-assisted surgery, small incisions are given between the ribs which allows the surgeon to insert tools connected to robotic arms. To make it more accessible imaging technology allows surgeons to see inside the heart throughout the procedure and surgeons hand control the robotic arm to complete the surgery.¹

Intraoperative procedure

Tumor resection

Simple tumor resection

This resection is done for benign tumours like myxomas. The heart lung machine must be connected to avoid dislodging any tumour material. To reduce the chance of dislodgement surgeons open both atria from the right superior pulmonary vein without injuring the tumour or its base. The tumour can be then removed from the septum as a whole. Other chambers of the heart need to be inspected for the presence of any further tumours. Then the defect is closed with patch material. 

Complex tumour resection

This procedure is possible provided the mass of the tumor is restricted to the heart and if malignant should not have invaded the adjacent tissues.

In case tumors involve the right side of the heart the whole right half of the organ is resected. Circulation to the lungs is assured by the Fontan Circulation, commonly known as pediatric heart surgery.

Ex-situ resection

In cases where a tumour involves the posterior wall of the left atrium or dorsal great vessels, the heart can be removed from the thorax to perform complete resection. Conventional surgery can lead to an inadequate view of the tumor which may result in incomplete resection. Taking the heart out of the body is required for optimal visualization of all structures. After successful resection of the tumour heart anatomy is restored by using artificial materials such as prostheses, patches, valves or biological tissue before the heart is reimplanted to its position.³

Other treatment options

Implantation of an artificial heart

If the tumor involves the left side of the heart with no metastases implantation of an artificial heart is considered a treatment last resort particularly in young patients. Hemorrhages, thromboses, infections, and embolisms are complications that can occur after implantation of an artificial heart.³

Heart transplantation

Heart transplantation is the final treatment option in individual cases, in this procedure also metastases should be completely removed or ruled out before the heart transplantation. There is a certain risk of this surgery which includes micrometastases by the necessary immunosuppression.³

Postoperative care

After surgery, patients need to spend a few days in the intensive care unit for close monitoring. And later shift to a regular hospital room. Hospital stay is extended or reduced according to the recovery of the patient.¹

Complications of surgery and when to call a doctor after surgery.

Minimally invasive surgeries have lower risks and complications. Complications that may occur after surgery are 

1. Arrhythmia
2. Bleeding
3. Damage to blood vessels or organs
4. Infection (mediastinitis)
5. Stroke

You can call your doctor if you have the following complications:

1. Severe Chest pain
2. Fever
3. Nausea or vomiting
4. Shortness of breath
5. Infection near incision
6. Slurred speech¹

FAQs

1. What is heart tumour removal surgery?

A heart tumour is an abnormal growth of tissue in the heart. Removal of this tumour is called heart tumour removal surgery.

2. What causes heart tumours?

Myxomas are genetic in occurrence. Malignant tumors affected in another part of the body can spread to the heart like melanoma, breast or lung cancer.

3. When is heart tumour removal surgery required or recommended?

When it causes some non-specific symptoms like chest discomfort, dizziness, fainting, fatigue, fever and chills, heart palpitations and failure, joint pain, loss of appetite, shortness of breath etc.

4. Is heart tumour removal surgery painful?

No, this surgery is not painful as performed under anesthesia. And painkillers are prescribed after surgery for some days as per the surgeon and patient's condition.

5. Any other treatment options available than surgery?

Yes. Palliative care, heart transplantation and implantation of an artificial heart are the other treatment options available for heart surgery.

Summary 

Tumours of the heart are rare; these tumours are either benign or malignant. The heart is such an essential organ, even benign tumours can be life-threatening. Hence heart tumor removal surgery is one of the treatment options recommended by doctors and surgeons in many cases where it can be done successfully. 

Surgery can be done in various ways like open heart surgery or less complicated minimally invasive surgery both types of surgeries are performed under anesthesia. There are several complications related to the surgery. Doctors, surgeons and healthcare providers are the best people to contact in case of after-surgery complications. After any surgery, it’s important to follow your surgeon’s guidance on what to do and what to avoid during your recovery. 

The survival rate after surgery depends on many other health-related and age-related factors.