DOI QR코드

DOI QR Code

Surgical Outcomes of Cardiac Myxoma: Right Minithoracotomy Approach versus Median Sternotomy Approach

  • Lee, Han Pil (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, Won Chul (Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.08.31
  • Accepted : 2015.11.13
  • Published : 2016.10.05

Abstract

Background: The standard approach in treating cardiac myxoma is the median full sternotomy. With the evolution of surgical techniques, the right minithoracotomy approach has emerged as an alternative method. Since few studies have been published assessing the right minithoracotomy approach, we performed a retrospective study to compare the clinical outcomes of the right minithoracotomy approach with those of the sternotomy approach. Methods: From January 2005 to December 2014, 203 patients underwent resection of a cardiac myxoma. Patients with preexisting cardiac problems were excluded from this study. 146 patients were enrolled in this study; 83 patients were treated using a median sternotomy and 63 patients were treated using a right minithoracotomy. Results: No early mortalities were recorded in either group. Although the cardiopulmonary bypass time and aorta cross-clamp time were significantly shorter in the sternotomy group (p<0.001 and p=0.005), postoperative blood transfusions and arrhythmia events were significantly less common in the thoracotomy group (p=0.004 and p=0.025, respectively). No significant differences were found in the duration of the hospital stay, postoperative intubation time, the duration of the intensive care unit stay, and recurrence. Conclusion: The minimally invasive right minithoracotomy approach is a good alternative method for treating cardiac myxoma because it was found to be associated with a lower incidence of postoperative complications and a shorter postoperative recovery period.

Keywords

References

  1. 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;100:495-500. https://doi.org/10.1016/j.athoracsur.2015.03.007
  2. Bossert T, Gummert JF, Battellini R, et al. Surgical experience with 77 primary cardiac tumors. Interact Cardiovasc Thorac Surg 2005;4:311-5. https://doi.org/10.1510/icvts.2004.103044
  3. 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;91:79-84. https://doi.org/10.1016/j.athoracsur.2010.09.019
  4. Cho WC, Lee JW, Je HG, Kim JW. Comparison of mitral valve repair between a minimally invasive approach and a conventional sternotomy approach. Korean J Thorac Cardiovasc Surg 2007;40:825-30.
  5. Pezzella AT, Effler DB, Levy IE. Operative approaches to the left atrium and mitral valve apparatus. Tex Heart Inst J 1983;10:119-23.
  6. Gummert JF, Barten MJ, Hans C, et al. Mediastinitis and cardiac surgery: an updated risk factor analysis in 10,373 consecutive adult patients. Thorac Cardiovasc Surg 2002; 50:87-91. https://doi.org/10.1055/s-2002-26691
  7. Lee YO, Cho JY, Lee JT, Kim GJ. Comparison of the operative results of performing endoscopic robot assisted minimally invasive surgery versus conventional cardiac surgery. Korean J Thorac Cardiovasc Surg 2008;41:598-604.
  8. Navia JL, Cosgrove DM 3rd. Minimally invasive mitral valve operations. Ann Thorac Surg 1996;62:1542-4. https://doi.org/10.1016/0003-4975(96)00779-5
  9. Aybek T, Dogan S, Risteski PS, et al. Two hundred forty minimally invasive mitral operations through right minithoracotomy. Ann Thorac Surg 2006;81:1618-24. https://doi.org/10.1016/j.athoracsur.2005.12.006
  10. Ko PJ, Chang CH, Lin PJ, et al. Video-assisted minimal access in excision of left atrial myxoma. Ann Thorac Surg 1998;66:1301-5. https://doi.org/10.1016/S0003-4975(98)00759-0
  11. Sawaki S, Ito T, Maekawa A, et al. Outcomes of video-assisted minimally invasive approach through right mini-thoracotomy for resection of benign cardiac masses; compared with median sternotomy. Gen Thorac Cardiovasc Surg 2015;63:142-6. https://doi.org/10.1007/s11748-014-0456-0
  12. Mihos CG, Santana O, Lamas GA, Lamelas J. Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery. J Thorac Cardiovasc Surg 2013;146:1436-41. https://doi.org/10.1016/j.jtcvs.2012.09.009
  13. Pineda AM, Santana O, Zamora C, Benjo AM, Lamas GA, Lamelas J. Outcomes of a minimally invasive approach compared with median sternotomy for the excision of benign cardiac masses. Ann Thorac Surg 2011;91:1440-4. https://doi.org/10.1016/j.athoracsur.2011.01.057

Cited by

  1. Mini Right Anterior Thoracotomy Approach versus Sternotomy for Resection of Intracardiac Myxoma vol.13, pp.4, 2016, https://doi.org/10.1097/imi.0000000000000542
  2. Minimally invasive and conventional surgical treatment of primary benign cardiac tumors vol.14, pp.None, 2016, https://doi.org/10.1186/s13019-019-0890-2