This study analyzed the advantages and feasibility of non-open-heart surgery without cardiopulmonary bypass for intracardiac intravenous leiomyomatosis.

We retrospectively reviewed 23 cases of intracardiac intravenous leiomyomatosis and divided them into a non-cardiopulmonary bypass group (NCPB group, nine cases) and a cardiopulmonary bypass group (CPB group, fourteen cases) based on their surgical treatment. Clinical characteristics and anatomical features, including the diameters of the tumor, right atrium, and inferior vena cava, were recorded, and perioperative data, including the operation time, blood loss, postoperative hemoglobin change, and follow-up results, were analyzed and compared between the two groups.

The NCPB group had a shorter operation time (321.9±104.2 min vs. 526.3±95.6 min, p<0.001) and less blood loss (456.3±249.9 mL vs. 815.4±435.6 mL, p=0.048) than the CPB group. The NCPB group had a small maximum cross-sectional area of the tumor inside the right atrium (475.5±509.6 mm2), a low percentage of the maximum cross-sectional area of the entrance of the right atrium (average 26.1%), no tricuspid valve or atrial wall involvement, and high mobility inside the inferior vena cava and heart chamber. All 23 patients recovered well postoperatively, and there was no recurrence during 24 months of follow-up.

For intravenous leiomyomatosis with a smaller cross-sectional area in the right atrium that can be mobilized, surgery without cardiopulmonary bypass is feasible and should be considered.