Minimally invasive approach for excision of left atrial myxoma-an 8-year single-center experience

With the objective to present a minimally invasive surgical approach for excision of left atrial (LA) myxoma via right anterior thoracotomy (RAT), offering a less traumatic alternative to conventional median sternotomy, patients admitted in the department of Cardiothoracic and Vascular Surgery (CTVS), Sawai Man Singh (SMS) Hospital, from January 2017 to December 2024 with isolated intra-cavitatory LA mass with no other cardiac pathology were included in this prospective study. After informed consent, all participants underwent myxoma excision via the RAT approach. The average clamp time ranged from 18 to 30 minutes and pump time between 30 and 45 minutes. Postoperative drain output averaged 50-75 cc which was notably less than seen in conventional sternotomy. The average cardiac intensive care unit (C-ICU) stay was also shorter. There was no procedure-related morbidity or mortality. Patients reported high satisfaction due to improved scar cosmesis. Thus, we conclude that cardiac myxomas, the most common benign cardiac tumors, typically arise in the left atrium, with a myriad of clinical presentations. Surgical resection by midline sternotomy remains the definitive treatment worldwide. However, we present LA myxoma excision via a RAT approach as a less traumatic alternative. Our technique avoids femoral cannulation (no femoral site complications and extra access ports), uses conventional instruments (cost-effectiveness), and eliminates sternotomy. It achieves similar cardiopulmonary bypass (CPB) time (30-45 minutes) and clamp times (18-30 minutes), lower drain output (50-75 cc), and shorter C-ICU stay and operative time, with excellent cosmetic results (small, cosmetic scar) and high patient satisfaction, without procedure-related complications.