Surgical Outcomes of Cardiac Myxoma Resection Through Right Mini-Thoracotomy

Background With recent advances in cardiac surgery through minimal access, mini-thoracotomy has emerged as an excellent alternative for cardiac myxoma resection. This study analyzed the surgical results of this approach, focusing on postoperative cerebral embolism and tumor recurrence. Methods We retrospectively reviewed 64 patients (mean age, 56.0±12.1 years; 40 women) who underwent myxoma resection through mini-thoracotomy from October 2008 to July 2020. We conducted femoral cannulation and antegrade cardioplegic arrest in all patients. Patient characteristics and perioperative data, including brain diffusion-weighted magnetic resonance imaging (DWI) findings, were collected. Medium-term echocardiographic follow-up was performed. Results Thirteen patients (20.3%) had a history of preoperative stroke, and 7 (11.7%) had dyspnea with New York Heart Association functional class III or IV. Sixty-one cases (95.3%) had myxomas in the left atrium. The mean cardiopulmonary bypass and cardiac ischemic times were 69.0±28.6 and 34.1±15.0 minutes, respectively. Sternotomy conversion was not performed in any case, and 50 patients (78.1%) were extubated in the operating room. No early mortality or postoperative clinical stroke occurred. Postoperative DWI was performed in 32 (53%) patients, and 7 (22%) showed silent cerebral embolisms. One patient underwent reoperation for tumor recurrence during the study period; in that patient, a genetic study confirmed the Carney complex. Conclusion Mini-thoracotomy for cardiac myxoma resection showed acceptable clinical and neurological outcomes. In the medium-term echocardiographic follow-up, reliable resection was proven, with few recurrences. This approach is a promising alternative for cardiac myxoma resection.

[1]  S. Hussain,et al.  Cardiac Myxoma Embolization Causing Ischemic Stroke and Multiple Partially Thrombosed Cerebral Aneurysms , 2020, Stroke.

[2]  Jiaquan Zhu,et al.  Minimally invasive and conventional surgical treatment of primary benign cardiac tumors , 2019, Journal of Cardiothoracic Surgery.

[3]  S. Choo,et al.  Surgical Outcomes of Cardiac Myxoma: Right Minithoracotomy Approach versus Median Sternotomy Approach , 2016, The Korean journal of thoracic and cardiovascular surgery.

[4]  A. Lemaire,et al.  Femoral cannulation: a safe vascular access option for cardiopulmonary bypass in minimally invasive cardiac surgery , 2016, Perfusion.

[5]  H. Schaff,et al.  Cardiac Myxomas: A 50-Year Experience With Resection and Analysis of Risk Factors for Recurrence. , 2015, The Annals of thoracic surgery.

[6]  Andres M Pineda,et al.  Is a minimally invasive approach for resection of benign cardiac masses superior to standard full sternotomy? , 2013, Interactive cardiovascular and thoracic surgery.

[7]  M. Olschewski,et al.  Wound complications after median sternotomy: a single-centre study. , 2013, Interactive cardiovascular and thoracic surgery.

[8]  J. Smith,et al.  Robotic Excision of Atrial Myxoma , 2012, Journal of cardiac surgery.

[9]  Chan-Young Na,et al.  Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications , 2012, Cerebrovascular Diseases.

[10]  D. Loulmet,et al.  Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. , 2012, The Journal of thoracic and cardiovascular surgery.

[11]  Volkmar Falk,et al.  Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review , 2011, Innovations.

[12]  F. Mohr,et al.  Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison. , 2011, The Annals of thoracic surgery.

[13]  C. Mullany,et al.  Survival After Resection of Primary Cardiac Tumors: A 48-Year Experience , 2008, Circulation.

[14]  Robert D. Brown,et al.  Central nervous system manifestations of cardiac myxoma. , 2007, Archives of neurology.

[15]  R. Tam,et al.  Minimally invasive surgery for cardiac myxomas using an upper hemi-sternotomy and biatrial septal approach. , 2005, Heart, lung & circulation.

[16]  F. Mohr,et al.  Surgical experience with 77 primary cardiac tumors. , 2005, Interactive cardiovascular and thoracic surgery.

[17]  C. Stratakis,et al.  Clinical and molecular features of the Carney complex: diagnostic criteria and recommendations for patient evaluation. , 2001, The Journal of clinical endocrinology and metabolism.

[18]  K. Reynen.  Frequency of primary tumors of the heart. , 1996, The American journal of cardiology.

[19]  M. G. Farah.  Familial cardiac myxoma. A study of relatives of patients with myxoma. , 1994, Chest.

[20]  P. Leedman,et al.  THE COMPLEX OF MYXOMAS, SPOTTY PIGMENTATION AND ENDOCRINE OVERACTIVITY , 1986, Clinical endocrinology.

[21]  S. Batnitzky,et al.  Atrial myxoma : a review of the neurological complications , metastases , and recurrences , 2022 .

[22]  M. Jimenez-Martinez,et al.  Anterior mediastinitis as a complication of median sternotomy incisions: diagnostic and surgical considerations. , 1970, Surgery.

[23]  J. Hill,et al.  Surgical management of tumors of the heart. , 1967, Surgery.

[24]  R. Troccoli,et al.  [FREQUENCY OF PRIMARY AND SECONDARY TUMORS OF THE HEART. (DRAWN FROM STATISTICAL FINDINGS COLLECTED IN THE INSTITUTE OF PATHOLOGIC ANATOMY AND HISTOLOGY OF THE UNIVERSITY OF ROME FOR THE 10 YEAR PERIOD 1953-1962)]. , 1964, Annali della sanita pubblica.