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New Minimally Invasive Surgical Approach for Excision of Left Atrial Myxoma
Cristiano Spadaccio, Karim Elkasrawy, Fraser Sutherland.
Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom.

OBJECTIVE: The current approaches for left myxoma excision, i.e. inter-atrial groove incision (Sondergaard’s groove) or transeptal approach through the right atrium, present a number of shortcomings. The former requires an extensive dissection of the heart and penalizes visualization of the septum and site of tumor attachment, the latter, commencing the incision in the inferior margin of the septum, site of tumor’s pedicle in the majority of the cases, carries the risk of traumatic injury and embolization of the mass, and of division of the sinus node artery with conduction disturbances. In accordance to the recent trend in revisiting the left dome approach for mitral surgery, we propose a minimally invasive strategy restricted to the left atrium(LA) for myxoma excision. The rationale underlying this approach relies in its advantage in terms of surgical exposure and limited invasiveness on cardiac structures considering the benign nature of the disease
METHODS: 3 patients underwent excision of left atrial myxoma through the dome of the atrium, 2 of them by a mini J-sternotomy approach at the fourth intercostal space. Standard aortic and two-stage right atrial cannulation was performed. Dome of LA was incised in the angle between superior vena cava and aorta and tumor exposed and excised with its base en bloc from the inter-atrial septum. Atriotomy was closed with a running Prolene suture.
RESULTS: This technique provided optimal visualization of both the mass and the interatrial septum allowing for a rapid, safe and uncomplicated excision of the mass. After a single overnight stay in critical care patients were discharged to the floor on the first postoperative morning with mild analgesic requirements and left hospital on the fourth postoperative day.
CONCLUSIONS: The avoidance of wide incisions in the heart chambers and risks associated to the classical approaches combined with the clinical benefit deriving from the limited invasiveness of mini J-sternotomy, might render this restricted left atrial dome approach a useful strategy in the surgical armamentarium for left sided cardiac masses.

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