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Atrial Myxoma Excision With Minimally Invasive Approach: 10-year Experience
Erik Cura Stura, Cristina Barbero, Claudia Calia, Massimo Boffini, Mauro Rinaldi.
AOU Cittą della Salute e della Scienza di Torino, Torino, Italy.

OBJECTIVE: Atrial myxomas are the most common benign cardiac tumors. Surgical excision trough median sternotomy is the conventional approach while minimally invasive surgery (MIS) has become an alternative method in recent years. We reviewed our 10-year MIS experience for atrial myxoma excision.
METHODS: From 2009 to 2019, 1485 consecutive patients underwent MIS through a right-minithoracotomy in our department. Of these, 33(2%) were atrial myxoma excision.
RESULTS: 20 (61%) patients were female, mean age was 63.1±13.3 years and mean BMI was 25.2±5.0. Main comorbidities were hypertension (45%), diabetes (3%), COPD (6.1%), chronic renal failure (6.1%) and AF (10%). Mean EF was 61.2±7.7 % and mean PAPS was 31.0±10.4 mmHg. 3(9%) patients had undergone previous cardiac surgery. Mean EuroSCORE II was 1.67±1.52 and Logistic was 5.43±4.85. The tumor was in the left atrium in 27 (82%) patients and in the right atrium in 6 (18%). Peripheral cannulation through femoral artery was used in all patients. Thoracic clamp (59.3%) or endoballoon (40.7%) were used for left atrial myxomas excision while beating heart surgery with caval snaring was performed for myxomas located in right atrium. Mean cardiopulmonary bypass and cross-clamp time were respectively 69.7±25.5 and 42.3±19.6 min. There were no conversions to sternotomy, no postoperative complications except for major neurologic event occurred in only 1 patient. No patient needed reoperation for bleeding, haemodialysis, PM implantation or wound revision. Mean intubation time was 9.2±4.9 h, mean ICU-stay was 1.3±0.7 day and mean hospital-stay was 6.8±2.2 days. No tumor recurrence was reported.
CONCLUSIONS: MIS reported excellent results and can be considered a safe and feasible method for atrial myxoma excision.


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