Atrial Myxoma: Minimally Invasive versus Conventional Sternotomy Techniques

All articles of this category Objective: invasive cardiac surgery has evolved to become standard therapy for several cardiac pathologies at specialized centers. The goal of this study was to compare this technique to the conventional access via full median sternotomy for resection of atrial myxoma. Methods: This retrospective analysis included 63 consecutive patients receiving resection of atrial myxoma between 2008 and 2016. Diagnosis of myxoma was confirmed by histological examination. Minimally-invasive access resection via right anterolateral minithoracotomy was utilized in 29 cases (group I) while 34 patients were operated via full median sternotomy (group II). Results: Patients in group I were significantly younger compared with group II (53 ± 13 versus 65 ± 13; p < 0.001). Further preoperative characteristics were similar between the two groups. Diagnosis of myxoma was confirmed by histological examination in all patients. Mean size of atrial myxoma was 36 × 28 × 18 mm in group I and 42 × 31 × 19 mm in group II. Cross clamp time (77 ± 38 vs. 67 ± 39; p = 0.452) as well as duration of procedure (I: 215 ± 48 vs. II: 193 ± 66 minutes; p = 0.164) were similar in both groups. No significant differences in duration of postoperative ventilation (I: 346 ± 224 vs. II: 321 ± 182 minutes; p = 0.718) amount of postoperative drainage (I: 560 ± 261 vs. II: 581 ± 301 mL; p = 0.843) or need for red blood cell transfusion (21 vs. 32%; p = 0.387) were observed between groups. Duration of intensive care unit (1.8 ± 1.2 vs. 2.6 ± 2.0 days; p = 0.078) and length of hospital stay (6.7 ± 2.9 vs. 7.2 ± 1.9 days; p = 0.409) were similar in both groups. In group I, 2 minor perioperative strokes with mild hemiplegia were observed. Postoperative pacemaker implantation rate was 3% in Group I and 9% Group II ( p = 0.618), respectively. No wound healing disorder and no other major postoperative complications were seen in both groups. Conclusion: Minimally-invasive resection of atrial myxoma is safe and feasible without prolongation of cross-clamp or procedural times, whereby combining reduced surgical trauma with superior cosmetic results.