Surgical treatment of primary cardiac tumors: 20-year single center experience

Abstract

Introduction Primary cardiac tumors are a rare condition presenting with a variety of symptoms. The outcomes of their surgical treatment in the modern era from central Europe have not been recently reported. Aim To evaluate the short- and long-term outcomes of the cardiac tumor operations at our department throughout the last 20 years. Material and methods This was a retrospective analysis of all primary cardiac tumor operations performed at our institution between 2000 and 2020. Perioperative data were extracted from patient records. Long-term data were provided by the National Registry of Cardiac Surgery. Results Sixty procedures for primary cardiac tumor were performed throughout the study period. The most common type of tumor was myxoma (88%), followed by fibroelastoma (8%), lipoma (2%) and sarcoma (2%). There were 2 perioperative deaths (3%). The most common perioperative complication was atrial fibrillation (47%). One (2%) patient underwent reoperation 6 years later because of myxoma recurrence. We recorded 13 long-term deaths, but only 1 patient died as a consequence of cardiac tumor (sarcoma) 15 months after the surgery. Long-term survival of the cohort was comparable with the age- and sex-matched general population up to 15 years postoperatively (relative survival 0.91, CI 0.68–1.23). Rich histopathological illustrations are provided in the online supplementary material. Conclusions Surgical resection is the standard treatment of primary cardiac tumors. The outcomes of benign tumors are excellent and the long-term postoperative survival is comparable with the general population. The prognosis of malignant tumors remains poor.

A giant left atrial myxoma causing left-sided heart failure

“…Therefore, to prevent these life-threatening complications, early diagnosis and urgent excision of the tumor is considered essential. 2 , 3 , 7 …”

Left ventricular fibroma presenting as esophageal spasm: A case report

“…Tumor location and size determine the signs and symptoms which include chest pain, arrhythmias, heart murmurs, low cardiac output, and sudden cardiac death. [1][2][3][4]6,7 The differential diagnosis at presentation varies depending on presenting symptoms but may include esophageal spasm or perforation, achalasia, Barret's esophagus, aortic dissection, myocardial infarction, coronary artery disease, valvular heart disease, and arrhythmia, among others.…”

“…Management strategies for symptomatic cardiac tumors vary and include close follow-up for asymptomatic tumors, single ventricle palliation, cardiac transplant, and antiarrhythmic medications, although only surgical resection is curative. [1][2][3][4][5][6][7] Due to the symptomatic nature of the patient and large tumor size, the tumor was resected. Optimal surgical approach is paramount in these cases.…”

“…Primary tumors of the heart are rare with 0.03%-0.32% prevalence. [1][2][3][4] Fibromas are most commonly identified in utero or infancy and less commonly develop in adulthood. 2,3,5 Patients with cardiac fibromas are often asymptomatic until the tumor enlarges causing obstruction and nonspecific symptoms including dyspnea, cyanosis, chest pain, arrhythmias, and sudden death.…”

Cardiogenic shock among cancer patients

“…Primary cardiac tumors are extremely rare, with an autopsy frequency ranging from 0.001 to 0.03% ( 104 ). Most of these primary lesions are usually benign ( 119 ) but can also be malignant, such as cardiac sarcoma, which accounts for ~2% of primary cardiac tumors ( 120 ). In contrast, cardiac metastases are slightly more common ( 121 ), with up to 12% of CPs having metastases to the heart or pericardium at autopsy, although most of them remain clinically silent ( 122 , 123 ).…”