Atrial versus biatrial approaches for cardiac myxomas

Myxomas are the most common primary benign tumors of the heart. The objectives of this study were to review the different surgical approaches to intracardiac myxomas and to assess the long-term prognosis of these patients. We present a retrospective review of 58 intracardiac myxomas surgically removed at the Montreal Heart Institute between September 1975 and May 2002. Nineteen male and 38 female patients with a mean age of 56±13 years were operated for cardiac myxoma. Atrial and biatrial approaches were used in 41 and 59% of cases, respectively. The mean follow-up was 8.8±6.4 years. Supraventricular arrhythmias and conduction disturbances were the most frequent complications following surgery (39%). One patient died early from malignant arrhythmia and eight other patients succumbed during the follow-up period with two cardiac-related deaths from recurrent myxoma and endocarditis, respectively. The overall 10-year actuarial survival was 86±6%. The retrospective comparison of atrial versus biatrial approaches showed marginal difference in the procedural time and no significant difference in blood losses, transfusion requirements, length of stay, postoperative NYHA functional class and survival. Notwithstanding the approach performed, the surgical treatment of cardiac myxomas is associated with a low operative mortality and good long-term outcome.