Cardiac myxoma: The influence of surgical technique on long-term prognosis

The aim of our study was to analyze the influence of different surgical techniques (left atriotomy, right atriotomy, biatrial approach and tumor basis solving) on early and late outcomes of patients operated on for cardiac myxoma. We evaluated 74 patients operated on for cardiac myxoma from 1982 through 2011. Sixty-six patients (89.19%) had left atrial myxoma and 8 (10.81%) right atrial myxoma. Histopathologic examination confirmed the diagnosis of atrial myxoma in all patients. In analyzing different surgical techniques we found that they had no influence on the duration of extracorporeal circulation and aortic cross-clamp time. Mortality analysis revealed: no intraoperative mortality; early mortality in 2 patients; late mortality in 12 patients. Survival after 29 years was 81.08%. There were no myxoma recurrences. 83.78% of the patients had functional improvement. In our opinion the best approach for right atrial myxoma is through right atriotomy, for left atrial myxoma through left atriotomy, with a biatrial approach for large tumors of the left atrium or when exploration of all 4 chambers is necessary. Subendocardial excision or thermocauterization was used for small tumors with bases less than 5 mm. Myxoma with a wider basis, depending on the localization, were partially resected at the atrial septum in the whole thickness or subendocardial excision of the tumor basis