Surgical resection of cardiac myxoma—a 30-year single institutional experience

Abstract

BackgroundPrimary cardiac tumors are rare and myxoma constitutes the majority. The present study summarizes our 30-year clinical outcomes of surgical myxoma resection.MethodsBetween January 1986 and December 2015, 93 patients (30 men, 63 women; mean age, 54.7 ± 16.6 years) underwent surgical myxoma resection. The most common origin site was the left atrium. Surgery was performed via a biatrial approach in 74.2%, atrial septotomy through right atriotomy in 17.2%, and left atriotomy only in 8.6%. Mean myxoma size based on longest length was 4.73 ± 1.92 cm (range, 1.2–11.0 cm).ResultsThe mean follow-up duration was 9.9 ± 7.8 years (range, 0–29 years). In-hospital mortality was 3.2%. The most common postoperative complication was atrial fibrillation (4.3%). The 5-, 10-, and 30-year survival rates were 92.9%, 87.2%, and 75.5%, respectively. Recurrence occurred in two patients (2.1%), which were detected at 20 and 79 months after the first surgery, respectively.ConclusionsLong-term survival after myxoma resection was excellent and recurrence was rare. Based on our experience, surgical method did not affect the outcome.

Cardiac Myxomas: A single center experience and ten-years follow up

“…The basic principles of surgical resection of cardiac myxomas include adequate resection of the tumor, avoiding intra-operative embolization by the limitation of cardiac manipulation before aortic cross-clamping, avoiding excessive tumor manipulations to prevent fragmentation and meticulous intra-cardiac examination and irrigation to avoid leaving residual tumor [23]. In cases where the tumor is located at the close vicinity of the conduction tissue, the tumor resection is inevitably confined to the subendocardial level, rather than full thickness tissue removal.…”

“…Lee and colleagues advocated that a left atriotomy should be performed first, then the position and shape of the tumor is evaluated, and, if the tumor can be removed without manipulation, it is removed without an additional incision. If the attachment site and the margins are not obvious and excessive manipulation is expected, an additional right atriotomy is performed [23].…”

“…The bi-atriotomy approach (LA incision + RA incision ± TS) to cardiac myxomas was popularized by Cooley in 1973 [26] its advantages are excellent exposure and localization of the resection margin by direct visualization of the tumor pedicle, minimal manipulation of the tumor and it allows examination of all cardiac chambers and easy repair the septal defect [23]. On the other hand, it was criticized for being responsible for a high incidence of arrhythmias and conduction disturbances after resection of LA myxomas [28].…”

Non-Malignant Cardiac Tumors

“…Even with large tumors, primary reconstruction of the intra-atrial septum can be often performed as the size (width and length) of the associated stalk rarely correlates with the actual extent of septal tissue involvement. For large septal defects, reconstruction with bovine pericardium can easily be performed [16]. Depending on surgeon experience, preference, and tumor location, a right thoracotomy approach to either the left or right atrium can be considered [63].…”

“…(a): A small myxoma is attached to the left atrial side of the fossa ovalis. (b): An enlarged myxoma passes in and out of the mitral valve according to the cardiac cycle[16].…”