Mini Right Anterior Thoracotomy Approach versus Sternotomy for Resection of Intracardiac Myxoma

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The standard approach in treating cardiac myxoma is the median full sternotomy. After recent advances in surgical techniques, the mini right anterior thoracotomy has emerged as an alternative method. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We performed a retrospective study to compare the clinical outcomes of the mini right anterior thoracotomy approach with those of the sternotomy approach for resection of cardiac myxoma at the Montreal Heart Institute. There were 20 patients treated using a mini right anterior thoracotomy (4–5 cm) and 23 patients were treated using a median sternotomy. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> No early mortalities were found in either group. Although the cardiopulmonary bypass time and aorta cross-clamp time were not significantly different between the two groups (64.3 mn ± 18 and 37.2 mn ± 15 vs 54.3 mn ± 25 and 37.20 mn ± 2), preoperative blood loss (106 mn ± 95 vs 338 mn ± 270) was significantly less in the mini right anterior thoracotomy group. The intensive care unit and hospital stay (1.65 days ± 1.2 and 5.70 days ± 3) were shorter with the mini right anterior thoracotomy approach. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> A minimally invasive surgery through mini right anterior thoracotomy is a good alternative technique for treating cardiac myxoma. Despite the small size of the experience, there is a clear diminution in preoperative blood loss and an interesting trend toward a shorter intensive care unit and hospital stay. </jats:p></jats:sec>

Minimally invasive approaches to primary cardiac tumors: A systematic review and meta‐analysis

“…Our research revealed 11 studies fulfilling these inclusion criteria, 9–19 producing a pooled data set of 653 patients of whom 294 underwent MI and 359 underwent MS cardiac tumor excision (Table 3) (Figure 1). There was 100% concordance between reviewers equating to a Cohen's kappa coefficient of κ = 1.…”

“…Given that atrial myxoma was the most frequent cardiac mass, right mini‐thoracotomy was the most utilized minimally invasive access 10,11,14,15,17–19 ; for aortic valve masses a parasternal incision (4–5 cm with rib resection and reattachment) was performed in some cases 11 . Robotic or robotic assisted approach was used in Shilling, 12 Yang, 13 and Moss 16 …”

“…Our research revealed 11 studies fulfilling these inclusion criteria, [9][10][11][12][13][14][15][16][17][18][19] producing a pooled data set of 653 patients of whom 294 underwent MI and 359 underwent MS cardiac tumor excision (Table 3) ( Figure 1).…”

Minimally invasive resection of a giant left atrial myxoma: a case report

“…This strategy showed excellent results with short hospital stay, low intraoperative blood loss as well as cosmetically appealing outcome associated with less invasive treatment. 8 Thus, minimally invasive surgery might even improve reconvalescence after surgery and mortality that was described to be under 5% in conventionally operated patients. 9,10…”

Non-Malignant Cardiac Tumors

“…For large septal defects, reconstruction with bovine pericardium can easily be performed [16]. Depending on surgeon experience, preference, and tumor location, a right thoracotomy approach to either the left or right atrium can be considered [63]. While a left atrial approach has been described for tumors on the left atrial side of the intra-atrial septum, if such an approach is chosen, it is critical that the principles of complex tumor excision, including the stalk and septal roots (with reconstruction of the intra-atrial septum if necessary), be maintained [64].…”