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.	王詠, 肖穎彬, 陳林, 等. 心臟腫瘤 181 例外科治療的臨床分析. 中國胸心血管外科臨床雜志, 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.	黃茂勛, 朱志成, 朱翠琳, 等. 右胸微創小切口與傳統胸部正中切口左心房粘液瘤切除術的療效對比. 中國胸心血管外科臨床雜志, 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.	劉洪端, 李新, 于風旭, 等. 經右胸前外側小切口左心房粘液瘤切除術的療效分析. 中國胸心血管外科臨床雜志, 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.	劉健, 郭惠明, 謝斌, 等. 胸腔鏡下與傳統開胸左心房粘液瘤切除術的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 671-674.
9.	賀清, 俞世強, 徐學增, 等. 完全胸腔鏡與正中開胸治療心臟粘液瘤的病例對照研究. 中國胸心血管外科臨床雜志, 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, F?rber 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. 王詠, 肖穎彬, 陳林, 等. 心臟腫瘤 181 例外科治療的臨床分析. 中國胸心血管外科臨床雜志, 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. 黃茂勛, 朱志成, 朱翠琳, 等. 右胸微創小切口與傳統胸部正中切口左心房粘液瘤切除術的療效對比. 中國胸心血管外科臨床雜志, 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. 劉洪端, 李新, 于風旭, 等. 經右胸前外側小切口左心房粘液瘤切除術的療效分析. 中國胸心血管外科臨床雜志, 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. 劉健, 郭惠明, 謝斌, 等. 胸腔鏡下與傳統開胸左心房粘液瘤切除術的病例對照研究. 中國胸心血管外科臨床雜志, 2016, 23(7): 671-674.
9. 賀清, 俞世強, 徐學增, 等. 完全胸腔鏡與正中開胸治療心臟粘液瘤的病例對照研究. 中國胸心血管外科臨床雜志, 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, F?rber 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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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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

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