Mid-Term Outcomes after Surgery of Primary and Secondary Cardiac Sarcomas: Single-Center Experience

Objectives: 25% of all primary heart tumors are malign. Among them sarcomas present the most common fraction in various types (95%). The clinical course offers an aggressive growth, and usually lethal outcome. Secondary cardiac tumors are up to 100 times more common than primary ones but here are the sarcomas not a frequent finding. In this study we analyzed 14 patients undergoing resection of primary and secondary cardiac sarcomas in our institution.

Methods: Review of our cardiac sarcomas database from 2003 to 2016. We evaluated 14 patients, eight with primary and 6 with metastatic or infiltrative cardiac sarcomas who underwent surgical excision or palliative tumor reduction in our institution. Pre- and intraoperative risk factors, histological diagnoses and outcomes were analyzed.

Results: Mean age at the time of surgery was 50.7 ± 18.2 years. Five (35%) patients were female. Four patients had a history of benign and six patients of various malign tumors in another localization.

Among patients with primary cardiac sarcomas the most common localization of the neoplasm was pulmonary artery in 5 cases (36%), followed by atrium in 2 (14%) patients and pericardium in 1 (7%) patient. Angiosarcoma was in this group the most common histologic type (n = 4, 29%) followed by undifferentiated sarcoma in 3 cases (21%) and synovial sarcoma in 1 case (7%).

Secondary cardiac sarcomas were metastases in 2 (14%) cases and infiltrations of mediastinal (n = 3, 21%) and pulmonic (n = 1, 7%) sarcomas. Undifferentiated sarcoma was in this group the most common postoperative diagnosis (n = 3, 21%).

Two patients with primary cardiac sarcomas underwent redo surgery due to tumor recurrence at the 204. and 207. day after the first operation and they died at the 1. and at the 7. postoperative day, respectively. During a mean follow-up of 460 days, 11 (79%) patients died. Median survival was 223 days.

The age, intensive care duration and survival differences between the groups with primary and secondary cardiac sarcomas were not statistically significant (Mann-Whitney U-test)

Conclusion: Patients with cardiac sarcomas are often young, male and have poor outcomes. Extra- and intracardiac sarcomas seem to be a therapeutic challenge on the grounds of aggressive biological nature. Extensive combination of surgical resection and chemotherapy brings unfortunately only palliation of symptoms and limited survival rates.