Comparative Outcomes of Minimally Invasive Right Transaxillary and Sternotomy Approaches for Atrial Myxoma Resection: A Retrospective Comparative Experience

Background Minimally invasive cardiac lateral surgery (MICLAT‐S) via a right transaxillary approach has recently been established as a sternum‐sparing technique in valve surgery. Its role in atrial myxoma resection, however, has not been systematically assessed. This study provides a comparative evaluation of MICLAT‐S versus full sternotomy (FS) for atrial myxoma resection. Methods We retrospectively analyzed 90 patients undergoing atrial myxoma resection between 2015 and 2023: 50 via MICLAT‐S and 40 via FS. Baseline characteristics, intraoperative variables, and postoperative outcomes—including 30‐day mortality, myocardial infarction, and stroke—were compared. Secondary endpoints included perioperative morbidity, transfusion requirements, wound complications, and tumor recurrence. Results Tumors were significantly larger in the MICLAT‐S cohort, yet complete resection was feasible in all cases. Operative times were longer with MICLAT‐S, without adverse impact on outcomes. Major adverse cardio‐cerebral events occurred at comparable rates between groups. MICLAT‐S was associated with significantly lower transfusion needs. Wound complications, classified according to the Jones criteria, occurred only in the FS group (12.5%), with one‐stage IIA case requiring negative pressure therapy. Selective cryoablation of the tumor base was applied as an observational adjunctive measure in four patients (4.4%) with broad‐based tumor attachment. Postoperative stroke resulting in a modified Rankin score ≥ 2 occurred in 2.0% of patients in the MICLAT‐S group and 2.5% in the FS group. Conclusion MICLAT‐S is a safe and effective alternative to FS for atrial myxoma resection. It achieves equivalent safety with lower transfusion requirements and absence of wound complications. Despite longer operative times, clinical outcomes remain comparable, supporting MICLAT‐S as a valuable sternum‐sparing strategy in myxoma surgery.