Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

Abstract

ObjectiveWe aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery.MethodsWe retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections.ResultsForty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up.ConclusionAlthough myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

Cardiac Myxomas: A single center experience and ten-years follow up

“…Microscopically, myxoma is generally a hypocellular lesion with the prominent myxoid stromal background. The neoplastic cells are frequently stellate, or spindle in shape and tend to arrange singly or less frequently in small cords or nests and intramural hemorrhage and calcification were occasionally present [4]. In our series, the histopathological diagnosis was confirmed in all patients.…”

“…None of the patients in our study expressed familial inheritance. Cardiac myxoma may arise from the left atrium, right atrium, the atrioventricular valves, the ventricles, or may rarely originate from the ventricular free wall or atrial appendages [4], All the published series in the literature showed that the left atrium is the most common site of myxoma, with the tumor base on the inter-atrial septum in 80% of the cases. [4,8,9].…”

“…Cardiac myxoma may arise from the left atrium, right atrium, the atrioventricular valves, the ventricles, or may rarely originate from the ventricular free wall or atrial appendages [4], All the published series in the literature showed that the left atrium is the most common site of myxoma, with the tumor base on the inter-atrial septum in 80% of the cases. [4,8,9]. In sporadic reported cases, the tumor was attached to the valve leaflets or in other locations in the left atrial or ventricular wall [10].…”

“…Myxomas occur more frequently in females, and all age groups are affected; however, they present more likely between the third and sixth decades of life [3]. Although myxomas are benign, they carry the risk of systemic embolization with subsequent cerebral or peripheral infarctions, intra-cardiac obstructions, syncope, and sudden death; therefore, once the diagnosis is established, immediate surgical resection is recommended [4]. There is a debate about the best surgical approach to intra-cardiac myxoma [5].…”

Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients ’ experience

“…Yüksel et al 16 presented a retrospective study, which compared biatrial approach (n=34) with unilateral approach (n=8) and right atriotomy and right ventriculotomy (n=1) in patients with LA myxoma. They preferred biatrial approach for wide resection of the tumour and to avoid residual tumour.…”