Right Anterolateral Minithoracotomy versus Median Sternotomy Approach for Resection of Left Atrial MyxomaFunding This work was supported by grants from the National Natural Science Foundation of China (grand number 81300174, 31330029) and Research Fund for the Doctoral Program of Higher Education of China (fund number 20120142120078).
21 March 2016
22 April 2016
08 June 2016 (eFirst)
Background Minimally invasive surgery has become the standard approach for several cardiac diseases. In this retrospective study, we compared right anterolateral minithoracotomy (RALT) with standard median sternotomy (SMS) for resection of left atrial myxoma (LAM).
Materials and Methods From January 2009 to June 2015, the clinical data of patients who underwent RALT (n = 30) and SMS (n = 36) for resection of LAM in our hospital were collected. The preoperative clinical data and operative results were compared between the two groups.
Results There were no significant differences in aortic cross-clamp and cardiopulmonary bypass time between the two groups. The total incision length was significantly shorter in RALT group compared with SMS group (p < 0.001). For RALT and SMS groups, respectively, the intensive care unit length of stay was 29.2 ± 6.5 versus 43.5 ± 6.9 hours (p < 0.001), and the postoperative hospital length of stay was 5 days (interquartile range [IQR]: 4–6) versus 8 days (IQR: 7–10) (p < 0.001). The total cost in RALT group was 27,000 RMB (IQR: 25,000–29,000) versus 33,000 RMB (IQR: 31,000–35,000) in SMS group (p < 0.001). There were no significant differences in mortality and postoperative complications between the two groups.
Conclusion RALT approach for LAM resection can be performed safely with favorable cosmetic outcome, accepted clinical results, and lower cost. It should be considered as a promising alternative to SMS and merit additional study.
- 1 Shapiro LM. Cardiac tumours: diagnosis and management. Heart 2001; 85 (02) 218-222
- 2 Imperio J, Summers D, Krasnow N, Piccone Jr VA. The distribution patterns of biatrial myxomas. Ann Thorac Surg 1980; 29 (05) 469-473
- 3 Vistarini N, Alloni A, Aiello M, Viganò M. Minimally invasive video-assisted approach for left atrial myxoma resection. Interact Cardiovasc Thorac Surg 2010; 10 (01) 9-11
- 4 Actis Dato GM, De Benedictis M, Actis Dato Jr A, Ricci A, Sommariva L, De Paulis R. Long-term follow-up of cardiac myxomas (7-31 years). J Cardiovasc Surg (Torino) 1993; 34 (02) 141-143
- 5 Larrieu AJ, Jamieson WR, Tyers GF. , et al. Primary cardiac tumors: experience with 25 cases. J Thorac Cardiovasc Surg 1982; 83 (03) 339-348
- 6 Shahian DM, Labib SB, Chang G. Cardiac papillary fibroelastoma. Ann Thorac Surg 1995; 59 (02) 538-541
- 7 Iribarne A, Easterwood R, Russo MJ. , et al. Long-term outcomes with a minimally invasive approach for resection of cardiac masses. Ann Thorac Surg 2010; 90 (04) 1251-1255
- 8 Reber D, Birnbaum DE. Recurrent cardiac myxoma: why it occurs. A case report with literature review. J Cardiovasc Surg (Torino) 2001; 42 (03) 345-348
- 9 Bjessmo S, Ivert T. Cardiac myxoma: 40 years' experience in 63 patients. Ann Thorac Surg 1997; 63 (03) 697-700
- 10 Brown ML, McKellar SH, Sundt TM, Schaff HV. Ministernotomy versus conventional sternotomy for aortic valve replacement: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2009; 137 (03) 670-679.e5
- 11 Luo H, Wang J, Qiao C, Zhang X, Zhang W, Song L. Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect. J Thorac Cardiovasc Surg 2014; 148 (01) 188-193
- 12 Cohn LH, Adams DH, Couper GS. , et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226 (04) 421-426 , discussion 427–428
- 13 Glower DD, Landolfo KP, Clements F. , et al. Mitral valve operation via Port Access versus median sternotomy. Eur J Cardiothorac Surg 1998; 14 (Suppl. 01) S143-S147
- 14 Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol 2010; 56 (06) 455-462
- 15 Lamelas J, Sarria A, Santana O, Pineda AM, Lamas GA. Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater. Ann Thorac Surg 2011; 91 (01) 79-84
- 16 Black D, Pearson M. Average length of stay, delayed discharge, and hospital congestion. BMJ 2002; 325 (7365): 610-611
- 17 Navia JL, Cosgrove III DM. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62 (05) 1542-1544
- 18 Chitwood Jr WR, Elbeery JR, Chapman WH. , et al. Video-assisted minimally invasive mitral valve surgery: the “micro-mitral” operation. J Thorac Cardiovasc Surg 1997; 113 (02) 413-414