Totally endoscopic resection of right atrial myxoma on beating heart: a case serries

There are few reports on totally endoscopic resection of right atrial (RA) myxoma, all of which were performed after aortic cross-clamping. Beating-heart RA myxoma resection through small trocars and port represents a novel, simple, and safe approach. Three patients were diagnosed with RA myxomas arising from the interatrial septum, with sizes ranging from 20 to 64 mm. In two cases, the masses were immobile or minimally mobile, while the remaining patient exhibited significant mobility of the mass through the tricuspid valve, resulting in moderate regurgitation. All patients successfully underwent totally endoscopic myxoma resection on beating heart. Compared to procedures involving aortic cross-clamping, beating-heart surgery offers several advantages: (1) reduced operation times, lowered risk of aortic root complications, and shortened training duration for surgeons. Air embolism prevention techniques, including CO₂ insufflation, arterial pressure control, and keeping the left atrium full of blood, have been demonstrated to be safe through experimental models and large-scale clinical studies.