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Minimally Invasive And Conventional Surgical Treatment Of Cardiac Myxomas. A National Center Experience
Julio Alberto Moron Castro;
INCOR, Lima, Peru
BACKGROUND: Cardiac myxomas have a low incidence and silent clinical presentation. Traditionally, the approach to this pathology through median sternotomy has been the gold standard, however, in the last decade, minimally invasive surgery has become an attractive alternative. In the present study we present the surgical results of the minimally invasive surgery approach through right anterolateral minithoracotomy and the median sternotomy approach.
METHODS: From January 2016 to July 2023, 64 patients with a histopathological diagnosis of myxoma underwent surgical treatment using a minimally invasive or conventional approach in our service. Data were collected from medical records. Perioperative and follow-up results were compared between both groups.
RESULTS: A total of 64 patients were included in the study, 14 were men and 50 were women with a median age of 58.5 ± 17.1. The most frequent location of myxoma was the left atrium (n = 50, 78.1%), followed by the right atrium (n = 7, 10.9%), left ventricle (n = 4, 2%) and right ventricle (n = 3, 4.6%). All patients had surgery without complications distributed in 50 cases (78.1%) by median sternotomy and 14 cases (21.8%) by right anterolateral minithoracotomy. There was no statistical significance between both groups in terms of extracorporeal circulation time, aortic clamping time, orotracheal intubation time, ICU length of stay and length of hospital stay. Patients with anterolateral minithoracotomy had less postoperative bleeding (250 ± 180 vs 450 ± 190 ml, P < 0.01) than those who underwent median sternotomy. There were no reoperations due to excessive bleeding. There was no perioperative mortality, only one case of recurrence occurred during follow-up.
CONCLUSIONS: Surgical treatment of cardiac myxoma is safe and curative. The minimally invasive approach offers less postoperative bleeding compared to median sternotomy, offering a promising alternative.
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