Right anterolateral minithoracotomy <i>versus</i> traditional median sternotomy in left atrial myxoma treatment: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Fengxiao , WANG Weifan , WANG Shixiong , WANG Wei , MA Qi , XUE Yu ,  LIU Debin , GAO Bingren , SUN Jing

Department of Cardic Surgery, Lanzhou University Second Hospital, Lanzhou, 730030, P.R.China;

Corresponding author：

LIU Debin, Email: 670939400@qq.com

Keywords：

Myxoma; right anterolateral minithoracotomy; clinical effects; embolism; recurrence

DOI：

10.7507/1007-4848.201804064

Video：

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Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma. Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method: a right anterolateral minithoracotomy group including 15 patients, with 7 males and 8 females, aged 45.1±15.4 years; a median sternotomy group including 26 patients, with 10 males and 16 females, aged 49.4±11.9 years. The clinical data of the two groups were compared. Results There was no significant difference in preoperative clinical data between the two groups. All patients completed the operation without perioperative death. There was no significant difference in the operation time, cardiopulmonary bypass time, aortic clamp time or the incidence of postoperative complications between the two groups. However, compared with the median sternotomy group, the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation, ICU stay and postoperative hospital stay, and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05). After 3–106 months follow-up, no recurrence was observed in both groups. Conclusion Compared with traditional median sternotomy for left atrial myxoma resection, right anterolateral minithoracotomy is safe, effective and less traumatic. It can be used as a routine treatment for left atrial myxoma.

Citation： HE Fengxiao, WANG Weifan, WANG Shixiong, WANG Wei, MA Qi, XUE Yu, LIU Debin, GAO Bingren, SUN Jing. Right anterolateral minithoracotomy versus traditional median sternotomy in left atrial myxoma treatment: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 78-82. doi: 10.7507/1007-4848.201804064 Copy

1.	Ito S, Endo A, Okada T, et al. Acute myocardial infarction due to left atrial myxoma. Intern Med, 2016, 55(1): 49-54.
2.	王咏, 肖颖彬, 陈林, 等. 心脏肿瘤 181 例外科治疗的临床分析. 中国胸心血管外科临床杂志, 2013, 20(2): 155-158.
3.	Shah IK, Dearani JA, Daly RC, et al. Cardiac myxomas: a 50-year experience with resection and analysis of risk factors for recurrence. Ann Thorac Surg, 2015, 100(2): 495-500.
4.	黄茂勋, 朱志成, 朱翠琳, 等. 右胸微创小切口与传统胸部正中切口左心房粘液瘤切除术的疗效对比. 中国胸心血管外科临床杂志, 2016, 23(6): 554-557.
5.	Spadaccio C, Elkasrawy K, Fwh S. New minimally invasive surgical approach for excision of left atrial myxoma. Gen Thorac Cardiovasc Surg, 2017, 65(10): 605-608.
6.	刘洪端, 李新, 于风旭, 等. 经右胸前外侧小切口左心房粘液瘤切除术的疗效分析. 中国胸心血管外科临床杂志, 2015, 22(1): 36-38.
7.	Dong NG, Zhang KL, Wu L, et al. Right anterolateral minithoracotomy versus median sternotomy approach for resection of left atrial myxoma. Thorac Cardiovasc Surg, 2018, 66(2): 193-197.
8.	刘健, 郭惠明, 谢斌, 等. 胸腔镜下与传统开胸左心房粘液瘤切除术的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(7): 671-674.
9.	贺清, 俞世强, 徐学增, 等. 完全胸腔镜与正中开胸治疗心脏粘液瘤的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(12): 1142-1145.
10.	Schilling J, Engel AM, Hassan M, et al. Robotic excision of atrial myxoma. J Card Surg, 2012, 27(4): 423-426.
11.	Yuan SM. Mitral valve myxoma: clinical features, current diagnostic approaches, and surgical management. Cardiol J, 2012, 19(1): 105-109.
12.	Zhang RD, Zeng ZH, Zheng JY, et al. Left atrial myxoma complicated with multi-system embolization. J Cardiothorac Surg, 2017, 12(1): 76.
13.	Rose D, Papa A, Tomao S, et al. Cerebral metastases in patients with left atrial myxoma. J Card Surg, 2016, 31(5): 289-293.
14.	Schaff HV, Mullany CJ. Surgery for cardiac myxomas. Semin Thorac Cardiovasc Surg, 2000, 12(2): 77-88.
15.	Ko PJ, Chang CH, Lin PJ, et al. Video-assisted minimal access in excision of left atrial myxoma. Ann Thorac Surg, 1998, 66(4): 1301-1305.
16.	Deshpande RP, Casselman F, Bakir I, et al. Endoscopic cardiac tumor resection. Ann Thorac Surg, 2007, 83(6): 2142-2146.
17.	Vistarini N, Alloni A, Aiello M, et al. Minimally invasive video-assisted approach for left atrial myxoma resection. Interact Cardiovasc Thorac Surg, 2010, 10(1): 9-11.
18.	Owais TA, Färber G, Garbade J, et al. Excision of a left atrial myxoma via a minimally-invasive technique: a possible routine access. Interact Cardiovasc Thorac Surg, 2011, 12(5): 875-877.
19.	Bossert T, Gummert JF, Battellini R, et al. Surgical experience with 77 primary cardiac tumors. Interact Cardiovasc Thorac Surg, 2005, 4(4): 311-315.
20.	Mihos CG, Santana O, Lamas GA, et al. Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1436-1441.
21.	Pineda AM, Santana O, Zamora C, et al. Outcomes of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses. Ann Thorac Surg, 2011, 91(5): 1440-1444.
22.	Han PL, Cho WC, Kim JB, et al. Surgical outcomes of cardiac myxoma: right minithoracotomy approach versus median sternotomy approach. Korean J Thorac Cardiovasc Surg, 2016, 49(5): 356-360.
23.	Petersen J, Pecha S, Detter C, et al. Atrial myxoma: minimally invasive versus conventional sternotomy techniques. Thorac Cardiovasc Surg, 2017, 65(S 01): S1-S110.

1. Ito S, Endo A, Okada T, et al. Acute myocardial infarction due to left atrial myxoma. Intern Med, 2016, 55(1): 49-54.
2. 王咏, 肖颖彬, 陈林, 等. 心脏肿瘤 181 例外科治疗的临床分析. 中国胸心血管外科临床杂志, 2013, 20(2): 155-158.
3. Shah IK, Dearani JA, Daly RC, et al. Cardiac myxomas: a 50-year experience with resection and analysis of risk factors for recurrence. Ann Thorac Surg, 2015, 100(2): 495-500.
4. 黄茂勋, 朱志成, 朱翠琳, 等. 右胸微创小切口与传统胸部正中切口左心房粘液瘤切除术的疗效对比. 中国胸心血管外科临床杂志, 2016, 23(6): 554-557.
5. Spadaccio C, Elkasrawy K, Fwh S. New minimally invasive surgical approach for excision of left atrial myxoma. Gen Thorac Cardiovasc Surg, 2017, 65(10): 605-608.
6. 刘洪端, 李新, 于风旭, 等. 经右胸前外侧小切口左心房粘液瘤切除术的疗效分析. 中国胸心血管外科临床杂志, 2015, 22(1): 36-38.
7. Dong NG, Zhang KL, Wu L, et al. Right anterolateral minithoracotomy versus median sternotomy approach for resection of left atrial myxoma. Thorac Cardiovasc Surg, 2018, 66(2): 193-197.
8. 刘健, 郭惠明, 谢斌, 等. 胸腔镜下与传统开胸左心房粘液瘤切除术的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(7): 671-674.
9. 贺清, 俞世强, 徐学增, 等. 完全胸腔镜与正中开胸治疗心脏粘液瘤的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(12): 1142-1145.
10. Schilling J, Engel AM, Hassan M, et al. Robotic excision of atrial myxoma. J Card Surg, 2012, 27(4): 423-426.
11. Yuan SM. Mitral valve myxoma: clinical features, current diagnostic approaches, and surgical management. Cardiol J, 2012, 19(1): 105-109.
12. Zhang RD, Zeng ZH, Zheng JY, et al. Left atrial myxoma complicated with multi-system embolization. J Cardiothorac Surg, 2017, 12(1): 76.
13. Rose D, Papa A, Tomao S, et al. Cerebral metastases in patients with left atrial myxoma. J Card Surg, 2016, 31(5): 289-293.
14. Schaff HV, Mullany CJ. Surgery for cardiac myxomas. Semin Thorac Cardiovasc Surg, 2000, 12(2): 77-88.
15. Ko PJ, Chang CH, Lin PJ, et al. Video-assisted minimal access in excision of left atrial myxoma. Ann Thorac Surg, 1998, 66(4): 1301-1305.
16. Deshpande RP, Casselman F, Bakir I, et al. Endoscopic cardiac tumor resection. Ann Thorac Surg, 2007, 83(6): 2142-2146.
17. Vistarini N, Alloni A, Aiello M, et al. Minimally invasive video-assisted approach for left atrial myxoma resection. Interact Cardiovasc Thorac Surg, 2010, 10(1): 9-11.
18. Owais TA, Färber G, Garbade J, et al. Excision of a left atrial myxoma via a minimally-invasive technique: a possible routine access. Interact Cardiovasc Thorac Surg, 2011, 12(5): 875-877.
19. Bossert T, Gummert JF, Battellini R, et al. Surgical experience with 77 primary cardiac tumors. Interact Cardiovasc Thorac Surg, 2005, 4(4): 311-315.
20. Mihos CG, Santana O, Lamas GA, et al. Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery. J Thorac Cardiovasc Surg, 2013, 146(6): 1436-1441.
21. Pineda AM, Santana O, Zamora C, et al. Outcomes of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses. Ann Thorac Surg, 2011, 91(5): 1440-1444.
22. Han PL, Cho WC, Kim JB, et al. Surgical outcomes of cardiac myxoma: right minithoracotomy approach versus median sternotomy approach. Korean J Thorac Cardiovasc Surg, 2016, 49(5): 356-360.
23. Petersen J, Pecha S, Detter C, et al. Atrial myxoma: minimally invasive versus conventional sternotomy techniques. Thorac Cardiovasc Surg, 2017, 65(S 01): S1-S110.

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Right anterolateral minithoracotomy versus traditional median sternotomy in left atrial myxoma treatment: A case control study

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