Mid-Term Outcomes and Predictors of Mortality after Surgical Therapy of Cardiac Myxomas

Objectives: Primary heart tumors are rare and mostly benign. Because of the risk of malignancy, embolism or hemodynamics impairment they are often treated surgically. Myxomas are most frequent benign cardiac neoplasms. The aim of our study was to investigate the risk factors, oncological characteristics, mid-term outcomes and complications in patients, who were operated in our institution due to cardiac myxomas.

Methods: 96 patients underwent surgery in our clinic between March 2005 and October 2015 with the postoperative diagnose of cardiac myxoma. The mean age of population was 60.6 ± 14.2 years and 62 (64.6%) of patients were female. The preoperative conditions, intraoperative factors and outcomes were reviewed.

Results: The mean BMI was 26.4 ± 4.9. The preoperative diagnose was exact in 86 (90%) of patients. 17 (18%) of patients had already had a history of malign tumors in another localization, whereas 14 (15%) were diagnosed as having other benign tumors. 21 (22%) subjects suffered from various thyroid gland pathologies. 59 Patients (69%) were symptomatic and the most frequent symptoms were dyspnea or chest pain (38%), cerebral ischemia (15%) and fever (6%). Left atrial myxomas were diagnosed in 89 (93%) cases. In 70 patients (73%) the tumors were attached to the atrial septum. The mean dimension of the tumor was 36 ± 20 mm.

In all patients the median sternotomy was performed and in 80 (83%) patients the simple extirpation of the tumor was achieved, whereas in 16 (17%) cases the operation was combined with valve or coronary artery bypass surgery. The mean cardiopulmonary bypass (CPB) duration was 86.8 ± 40 minute. In 2 (2%) subjects the tumor resection was histologically subtotal. We observed major neurological complications in 4 (4.1%) of patients, in 5 (5.2%) a re-thoracotomy was needed in consequence of bleeding. Mean intensive care duration was 1.5 ± 1 days and there were no in-hospital deaths.

There was an inverse correlation between CPB duration and mid-term mortality (Spearman's rho p = 0.03). Intraoperative hypothermia was correlated with better mid- term outcomes (p = 0.02). There was a correlation between the mid-term mortality and the serum creatinine level (SCL) right after the surgery but not with the SCL at the admission. Mean follow-up time was 5.7 ± 4.4 years and 18 (19%) of patients died during this time. There were no recurrences.

Conclusion: Patients who were operated due to cardiac myxomas have good mid-term survival rates.