This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by ElBardissi, A. W. Articles by Schaff, H. V. Search for Related Content PubMed PubMed Citation Articles by ElBardissi, A. W. Articles by Schaff, H. V. Pubmed/NCBI databases Medline Plus Health Information Heart Surgery Related Collections CV surgery: other Epidemiology

(Circulation. 2008;118:S7-S15.)
© 2008 American Heart Association, Inc.

Original Articles

Survival After Resection of Primary Cardiac Tumors

A 48-Year Experience

Andrew W. ElBardissi, MD, MPH; Joseph A. Dearani, MD; Richard C. Daly, MD; Charles J. Mullany, MD; Thomas A. Orszulak, MD; Francisco J. Puga, MD; Hartzell V. Schaff, MD

From the Brigham and Women’s Hospital (A.W.E.), and Harvard Medical School, Boston, Mass; and the Mayo Clinic (J.A.D., R.C.D., C.J.M., T.A.O., F.J.P., H.V.S.), Rochester, Minn.

Correspondence to Andrew W. ElBardissi, MD, MPH, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115. E-mail aelbardissi{at}partners.org

Background— Primary cardiac tumors are rare but have the potential to cause significant morbidity if not treated in an appropriate and timely manner. To date, however, there have been no studies examining survival characteristics of patients who undergo surgical resection.

Methods and Results— From 1957 to 2006, 323 consecutive patients underwent surgical resection of primary cardiac tumors; 163 (50%) with myxomas, 83 (26%) with papillary fibroelastomas, 18 (6%) with fibromas, 12 (4%) with lipomas, 28 (9%) with other benign primary cardiac tumors, and 19 (6%) with primary malignant tumors. Operative (30 day) mortality was 2% (n=6). Univariate analysis indicated that patients who underwent resection of fibromas and myxomas had superior survival characteristics in comparison to the remainder of tumor variants; these results were consistent after adjusting for age at surgery, year of surgery, and cardiovascular risk factors. Based on actuarial characteristics of the 2002 U.S. population, patients who underwent myxoma resection had survival characteristics that were not significantly different from that of an age and gender matched population (SMR 1.11, P=0.57) whereas those who underwent resection of fibromas (SMR 11.17, P=0.002), papillary fibroelastomas (SMR 3.17, P=0.0003), lipomas (SMR 5.0, P=0.0003), other benign tumors (SMR 4.63, P=0.003), and malignant tumors (SMR 101, P<0.0001) had significantly poorer survival characteristics. Furthermore, malignant tumors in younger patients were highly fatal (HR 0.899, P<0.0001). Although the most significant predictor of mortality was tumor histology, survival was also influenced the by the duration of CPB and NYHA III/IV; the impact of these risk factors varied with time. The cumulative incidence of myxoma recurrence was 13% and occurred in a younger population (42 versus 57 years, P=0.003) with the risk of recurrence decreased after 4 years.

Conclusions— Surgical resection of primary cardiac tumors is associated with excellent long-term survival; patients with cardiac myxomas have survival characteristics that are not significantly different from that of a general population. Predictors of mortality are primarily related to tumor histology but also include clinical characteristics such as symptomatology and duration of CPB.

Key Words: cardiac tumor • myxoma • lipoma • fibroma • malignant sarcoma • survival • surgical resection

This article has been cited by other articles:

				C. Kiblbock, W. Schutzenberger, J. Kammler, J. Demmer, and F. Leisch Transient loss of consciousness and a heart murmur BMJ, September 2, 2009; 339(sep02_2): b3323 - b3323. [Full Text]

				J. F. M. Marchini, A. J. Rodrigues, and A. Schmidt A ventricular thrombus mimicking a tumour BMJ Case Reports, September 1, 2009; 2009(aug31_1): bcr0620091944 - bcr0620091944. [Abstract] [Full Text]

				G. Thiene, M. Valente, M. Lombardi, and C. Basso CHAPTER 20 Tumours of the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]