Complex Atrioventricular Groove Heart Tumor Excision

Excision of a massive atrioventricular (AV) groove tumor combined with concomitant coronary artery bypass grafting (CABG) represents one of the most technically demanding procedures in complex cardiac surgery. These tumors, often intimately related to the circumflex coronary artery, coronary sinus, and posterior mitral annulus, require meticulous dissection to achieve complete resection while preserving myocardial integrity and avoiding injury to adjacent critical structures. After establishing cardiopulmonary bypass and achieving cardioplegic arrest, careful mobilization of the heart allows exposure of the AV groove, with stepwise tumor debulking or en bloc excision depending on infiltration depth. Reconstruction of the atrioventricular groove may necessitate patch augmentation with autologous pericardium or synthetic material to restore structural stability and prevent atrioventricular disruption. When significant coronary artery disease coexists - or when tumor resection compromises native coronary flow - CABG is performed using arterial or saphenous vein grafts to ensure adequate myocardial perfusion. The success of this combined approach depends on precise anatomical understanding, myocardial protection strategies, and coordinated perioperative management to optimize hemodynamics and reduce the risk of bleeding, arrhythmia, or low cardiac output syndrome.