Cardiac tumors present a unique and complex clinical challenge. They are classified into primary and secondary (metastatic) types. Primary cardiac tumors are rare, with a prevalence of 0.001% - 0.03% in autopsy studies. Among these, approximately 75% are benign, with myxomas accounting for over 50% of cases. The remaining 25% are malignant, with cardiac sarcomas being the most common. Secondary cardiac tumors, however, are significantly more prevalent, occurring 20 to 40 times more often than primary tumors. In fact, about 15% of patients with any form of cancer may develop heart metastases [1] [2] .

As the most common benign primary cardiac tumor, myxoma typically occurs between the third and sixth decades of life, with 94% of cases presenting as solitary tumors [3] . While myxomas can develop in any cardiac chamber, about 75% are found in the left atrium, 10% - 20% in the right atrium, and the remainder in the ventricles [4] . However, left atrial myxoma (LAM) is particularly common among adults, requiring prompt surgical removal due to the risk of valvular obstruction or embolization [5] .

Advances in diagnostic and surgical techniques have significantly improved the prognosis for patients with cardiac myxoma [6] [7] . Traditionally, the median sternotomy has been the standard approach for treating this condition. However, as surgical techniques have progressed, minimally invasive approaches have gained attention as promising alternatives. Several studies have shown favorable outcomes using a right thoracotomy for valve surgeries [8] [9] . Yet, due to the rarity of cardiac tumors, research specifically focused on cardiac myxoma remains limited. In this study, we present the clinical outcomes of a single-center comparison between the median sternotomy and right mini-thoracotomy approaches for treating cardiac myxoma involving the left atrium.

Table 1 presents the demographic data preadmission New York Heart Association (NYHA) functional classification, showing that the mean age in Group A was 51.00 ± 8.06 years, with 28.6% of patients aged 36 - 45, 35.7% aged 46 - 55, and 35.7% aged 56 - 65. Group B had a mean age of 51.60 ± 9.68 years, with similar age distributions. The majority of patients in both groups were female, with 64.3% in Group A and 78.6% in Group B. The mean BMI was 23.40 ± 1.10 in Group A and 21.99 ± 2.09 in Group B. The distribution of NYHA functional class between Group A (35.7% in Class II, 64.3% in Class III-IV) and Group B (42.9% in Class II, 57.1% in Class III-IV). There were no statistically significant differences in age, gender, BMI or preadmission NYHA functional classification between the groups.

Chi square & Unpaired t-test was performed to compare between the groups. N = total no. of study subjects, n = total no. of study subjects in each group, f = frequency of study subjects in each group; ns = not significant. NYHA = New York Heart Association.

Table 2 summarizes the coexisting conditions among the patients. In Group A, 35.7% of patients had hypertension (HTN), 21.4% had diabetes mellitus (DM), 21.4% had cerebrovascular accidents (CVA), and 7.1% had arrhythmia. In Group B, 50.0% had HTN, 21.4% had DM, and 28.6% had CVA, with no cases of arrhythmia reported. There were no statistically significant differences in the prevalence of these coexisting conditions between the two groups.

Data were expressed as frequency and percentage. Fisher’s exact test was performed to compare between the groups. p value < 0.05 was accepted as level of significance. N = total no. of study subjects, n = total no. of study subjects in each group, f = frequency of study subjects in each group, ns = not significant.

Table 3 details the intraoperative variables. Group A had a mean cardiopulmonary bypass time of 73.65 ± 14.30 minutes, aortic cross-clamp time of 39.36 ± 13.15 minutes, incision length of 20.86 ± 0.86 cm, and total operation time of 154.64 ± 3.59 minutes. In comparison, Group B had a mean bypass time of 94.29 ± 20.57 minutes, cross-clamp time of 51.14 ± 16.22 minutes, incision length of 6.07 ± 0.83 cm, and operation time of 177.07 ± 2.16 minutes. Significant differences were found between the two groups in all these intraoperative measures.

Data were expressed in Mean ± SD. Unpaired student’s t test was performed to compare between the groups. p value < 0.05 was accepted as level of significance. N = total no. of study subjects, n = total no. of study subjects in each group, ns = not significant, s = significant.

Table 4 outlines the postoperative outcomes. In Group A, the mean intubation time was 11.43 ± 2.87 hours, ICU stay was 68.20 ± 20.93 hours, VAS score was 5.00 ± 0.88, and hospital stay was 8.93 ± 2.46 days. Group B showed better outcomes, with a mean intubation time of 5.93 ± 1.73 hours, ICU stay of 30.34 ± 8.25 hours, VAS score of 3.21 ± 1.81, and hospital stay of 5.71 ± 0.91 days. Statistically significant differences were observed in all these postoperative variables. Group A had a 14.3% incidence of wound infections and neurological deficits, while no such complications occurred in Group B, though the difference was not statistically significant.

Data were expressed in Mean ± SD. Unpaired student’s t test and were performed to compare between the groups. P value < 0.05 was accepted as level of significance. VAS = Visual Analogue Scale. N = total no. of study subjects, n = total no. of study subjects in each group, ns = not significant, s = significant.

This study aimed to compare early postoperative outcomes between right mini-thoracotomy and standard median sternotomy in patients undergoing isolated left atrial myxoma excision. A total of 28 patients met the inclusion criteria, with 14 undergoing median sternotomy and 14 right mini-thoracotomy. Notably, no conversions from mini-thoracotomy to sternotomy were required.

The study found that left atrial myxoma predominantly affects the elderly female population, with patient ages ranging from 37 to 65 years. Similar observations have been reported in previous studies [10] [11] . While some researchers, such as Bire et al. [12] , noted that left atrial myxoma is exceptionally rare in the elderly. However, Akhter et al. [13] found that myxomas can occur at any age, with 80% of their patients ranging from 35 to 76 years old, and the interquartile range between 47 and 69 years. In contrast, Prichard [14] , Griffiths [15] , and Heath [15] reported a broader age distribution, with most patients presenting in their third to sixth decades. This difference may be due to improved patient monitoring and more selective criteria for surgical resection [16] .

Most participants in this study had a BMI of 23 - 25 kg/m² and a history of hypertension, diabetes, cerebrovascular accidents, or arrhythmia. Dixit et al. [17] reported a mean BMI of 17.5 kg/m² in atrial myxoma patients, while Lee et al. [18] found that hypertension and diabetes were common among patients undergoing myxoma resection.

Cardiopulmonary bypass time, aortic cross-clamp time, and total operation time were longer in the mini-thoracotomy group, but the incision length was significantly shorter compared to the median sternotomy group. Although sternotomy is the traditional approach for myxoma resection, it carries risks such as postoperative infection and mediastinitis due to longer surgical scars [19] . In contrast, mini-thoracotomy offers benefits like smaller incisions, shorter hospital stays, faster recovery, and better cosmetic outcomes [20] .

This study also found that intubation time, ICU stay, postoperative pain (VAS score), and overall hospital stay were significantly shorter in the mini-thoracotomy group, consistent with findings from other studies [11] [18] . Strict asepsis was maintained during surgery, and broad-spectrum intravenous antibiotics were administered for three days. While a few patients in the sternotomy group developed wound infections and neurological deficits, none were observed in the mini-thoracotomy group, aligning with previous research [4] [10] [18] [21] .

Despite efforts to maintain optimal care throughout the study, several limitations should be acknowledged. Although the same surgical team performed all procedures using a standardized approach for both groups, variations in patient characteristics such as gender and body weight may have influenced surgical exposure time and were not accounted for in the analysis. Additionally, the study was conducted at a single hospital, which may affect the generalizability of the findings. The use of purposive sampling could introduce selection bias, potentially influencing the results. Moreover, the relatively small sample size and shorter follow-up period compared to other studies are also limitations that must be considered.

To obtain more conclusive results, further studies should consider the following recommendations: conducting similar research with a larger sample size, implementing a multi-center approach, and extending the study period to allow for the comparison of long-term variables, such as tumor recurrence.

The right mini-thoracotomy approach demonstrates potential as an effective alternative to median sternotomy for the excision of isolated left atrial myxoma, providing benefits such as reduced surgical trauma, shorter ICU stays, and faster postoperative recovery. However, further research with larger and more diverse patient cohorts is needed to validate these findings and evaluate long-term outcomes, including tumor recurrence and survival rates.

We extend our heartfelt gratitude to the patients and their families who participated in this study, generously contributing their time and cooperation. We are also deeply thankful to the teaching staff, colleagues, and medical personnel whose unwavering dedication and invaluable assistance were instrumental throughout this research.

The first author spearheaded the conceptualization and design of the study, meticulously gathered data from the hospital, performed the data analysis, and drafted the manuscript. The third author contributed significantly to manuscript preparation and offered critical analysis of the study. The last author provided guidance throughout the entire research process. All authors collaborated in interpreting the findings and have jointly approved the final version of the manuscript.