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      Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases

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          Abstract

          Objective

          To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention.

          Methods

          Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5–15) years.

          Results

          The cross-clamp time and cardiopulmonary bypass times were 41.1 ± 21.4 and 65.2 ± 27.3 min, respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7% ( n = 3). During the follow-up period, tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis, age (HR = 1.05, 95% CI: 1.02–1.09, P < 0.001), left atrial diameter (HR = 1.23, 95% CI: 1.08–1.36, P = 0.012), and mitral valve surgery (HR = 1.17, 95% CI: 1.05–1.29, P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07, 95% CI: 1.04–1.10, P = 0.003) and multiple surgical procedures (HR = 1.18, 95% CI: 1.06–1.29, P = 0.012) were significantly associated with overall mortality.

          Conclusions

          Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age, left atrial diameter, and mitral valve surgery were independent predictors of outcomes.

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          Most cited references24

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          Surgical ablation of atrial fibrillation during mitral-valve surgery.

          A. Marc Gillinov, Annetine Gelijns, Michael K Parides … (2015)
          Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited.
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            Cardiac myxomas: 24 years of experience in 49 patients.

            H. Schuchlenz, Christopher I. Keeling, G Tilz … (2002)
            In this single-center study we reviewed our experience with a significant number of cardiac myxoma cases occurring over the past two decades. Cardiac myxomas represented 86% of all surgically treated cardiac tumors at our center. Specifically, there were 49 consecutive patients, each with at least one myxoma. A detailed clinical, immunological, and echocardiographic long-term examination of 37 patients revealed one recurrent myxoma. Most myxomas originated from the left atrium (87.7%), but also much less frequently from the mitral valve (6.1%), from the right atrium (4.1%), and from the left and right atria (2.0%). The myxomas produced a prolapse into the left ventricle in 40.8% of the patients, mitral stenosis in 10.2%, and threatened left ventricular outflow tract obstruction in 2.0%. Multiple myxomas were found in 20.4% of the patients. Cardiac signs appeared in 93.9% of the patients. Preoperative embolic events had occurred in 26.5%. Immunologic alterations were present in 87.5%. For resection, a bilateral atriotomy was used. An additional aortotomy was needed to expose one mitral valve myxoma. Postoperatively, 81.1% of the patients remained without cardiac symptoms. The early mortality rate was 2.0% and the late mortality rate was 6.1%. Long-term prognosis was excellent with an actuarial survival rate of 0.74. Specific immunologic alterations were found in 71.4% of the patients. The actuarial freedom from reoperation of the myxoma was 0.96. The rate of reoperations was low with 2.0% after 24 years. Myxomas were usually detected and operated on in symptomatic patients. A high index of suspicion seems important for early diagnosis. Immunologic findings may play an additional role in confirming the diagnosis and the recurrence of a myxoma. Immediate surgical treatment was indicated because of the high risk of embolization or of sudden cardiac death. Also, a familial genesis must be excluded in myxoma patients.
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              Surgical excision of cardiac myxomas: twenty years experience at a single institution.

              Andrea Garatti, Giovanni Nano, Alberto Canziani … (2012)
              Primary cardiac tumors are quite uncommon and myxomas constitute the major proportion among these masses. The present study summarizes our 20-year clinical experience with surgical resection of intracardiac myxomas. Between January 1990 and December 2007, 98 patients (42 males, mean age 60.4±4.1 years) underwent complete excision of primary intracardiac myxoma. In 84 patients the origin site of the tumor was located in the left atrium, and the most common implant site was the interatrial septum. The most common symptom at admission was dyspnea, while systemic embolization was observed in 37 patients. Preoperative diagnosis was established in all patients by transthoracic echocardiography. All patients were operated through median sternotomy. Ninety-five patients (97%) survived the operation. Mean tumor dimension was 2.7±1.3 cm in largest diameter. According to the St. John Sutton classification (St. John Sutton MG, Mercier LA, Giuliani ER, et al. Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clin Pro 1980;55:371-6), solid tumors were detected in 43 patients (44%), while a papillary myxoma was found in 55 patients (56%). The follow-up was 100% complete, and the mean time to last follow-up was 98±60 months. Of the 95 survivors, 3 patients (3%) died at a mean follow-up of 72±45 months after surgery. Actuarial survival was 98%, 98%, and 89% at 5, 10, and 15 years, respectively. One patient operated for left atrial myxoma resection showed a recurrence 68 months after the first surgery. Although cardiac myxomas carry the risk of severe systemic and cardiac symptoms, prompt surgical excision gives excellent early and long-term results. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Geriatr Cardiol
                Journal ID (iso-abbrev): J Geriatr Cardiol
                Journal ID (publisher-id): JGC
                Title: Journal of Geriatric Cardiology : JGC
                Publisher: Science Press
                ISSN (Print): 1671-5411
                Publication date (Print): April 2019
                Volume: 16
                Issue: 4
                Pages: 338-343
                Affiliations
                [1 ]Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
                [2 ]Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
                [3 ]Center for Coronary Heart Disease, Department of Cardiology, Cardiovascular Institute & Fuwai Hospital, CAMS & PUMC, National Center for Heart Disease, Beijing, China
                [4 ]College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
                Author notes
                Correspondence to: Yan YAO & Mei-Sheng SHANG, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (YAO Y) and Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (SHANG MS). E-mails: iceyaya614@ 123456163.com (YAO Y) & sxtysms@ 123456163.com (SHANG MS)
                Article
                Publisher ID: jgc-16-04-338
                DOI: 10.11909/j.issn.1671-5411.2019.04.003
                PMC ID: 6503479
                PubMed ID: 31105754
                SO-VID: 6fac4cda-84ee-4e4a-a3f9-fa0e1061189c
                Copyright © Institute of Geriatric Cardiology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.

                History
                Date received : 27 October 2018
                Date revision received : 23 March 2019
                Date accepted : 2 April 2019
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: atrial fibrillation,atrial myxoma,embolism,survival
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: atrial fibrillation, atrial myxoma, embolism, survival

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