Хірургічні доступи при видаленні пухлин серця: значення вибору для радикальності й безпечності оперативного втручання, Surgical approaches in the resection of cardiac tumors: the importance of access selection for radicality and procedural safety

<jats:p>Cardiac tumors are rare but clinically significant conditions requiring surgical treatment. The radicality of tumor resection and prevention of recurrence largely depend on the appropriate choice of surgical access. Adequate visualization of the tumor implantation site and complete inspection of cardiac chambers determine both early and long-term outcomes.The aim – to optimize the selection of surgical approaches in the operative treatment of cardiac tumors based on one-center long-term clinical experience.Materials and methods. We retrospectively analyzed 1,061 patients who underwent surgical treatment for cardiac tumors between 1969 and 2026. Cardiac myxomas accounted for 948 (89.3%) cases, non-myxomatous benign tumors for 42 (4.1%), and malignant tumors for 71 (6.7%). Surgical approaches were evaluated according to tumor morphology, localization, and extent, as well as their impact on radical resection and recurrence rates.Results. In patients with left atrial myxomas, the transseptal approach via right atriotomy demonstrated the lowest rate of tumor fragmentation (21.2%) compared to the direct left atrial approach (39.5%) and allowed complete inspection of the interatrial septum. The overall recurrence rate of myxomas was 1.2% when radical resection principles were followed. For non-myxomatous tumors of valvular and intraventricular localization, combined and video-assisted approaches proved effective in achieving safe and precise tumor removal. In 98.6% of malignant tumor cases, median sternotomy was performed, with individualized cardiopulmonary bypass strategies and extended exposure of great vessels when required.Conclusions. A choice of surgical access is a decisive factor in achieving radical resection of cardiac tumors and preventing recurrence. For left atrial myxomas, the transseptal approach via right atriotomy provides optimal visualization of the implantation site and reduces the risk of residual tumor tissue. In non-myxomatous and malignant tumors, individualized access selection based on tumor localization and extent ensures oncological radicality and procedural safety.</jats:p>