Abstract 4144326: Mid-Term Outcomes of Surgical Resection of Pediatric Cardiac Fibroma and Modified Ventricular Reconstruction Procedure

Introduction: Primary cardiac fibroma (CF) was the second most common type of cardiac tumor, with surgical resection being the optimal strategy. However, as the tumor grew, a larger tumor also presented challenges during surgery. Particularly when compared to adults, children have smaller ventricles and thinner ventricular walls. The integrity of the ventricular wall decreased after the resection of large occupation, leading to reduced ventricular function or complications such as ventricular aneurysms. This study presents a single-center retrospective review of pediatric CF cases in our hospital, and presented the outcomes of our modified ventricular reconstruction procedure. Methods: We retrospectively reviewed pediatric patients under the age of 14 underwent CF resection and modified ventricular reconstruction procedure from January 2018 to December 2023, excluding metastatic cardiac tumors. 2 steps were performed during modified ventricular reconstruction procedure. Step 1: interventricular septum reconstruction. For larger defects, two pericardial stripes were used to clamp the defect on both sides of the endocardium and then running sutured, while primary closure for smaller ones. Step 2: free wall reconstruction. Two pericardial stripes were used to clamp resection margin on ventricular free wall and then running sutured. Results: 10 (58.9%) boys and 7 girls were included in this study, with a median age at surgery of 28.8 (7.8, 48.3) months and a median body weight of 13.0 (8.9, 15.3) kg. 7 patients had a tumor index (TI, the longest diameter of the cardiac tumor divided by the body surface area) greater than 10, with one patient reaching an exaggerated value of 22.1. During a median follow-up period of 17.4 months, no deaths, left ventricular failure, malignant arrhythmias, tumor recurrence were observed in the other patients. Conclusion: Our modified ventricular reconstruction procedure has proven successful. It has changed the fate of young patients with large tumors who would have otherwise needed heart transplants, offering high suture strength and reducing postoperative complications. Moreover, its relatively straightforward surgical approach facilitates learning and implementation in different centers.