Cardiac myxomas: a 27-year surgical experience

Abstract

Amac: Bu calismada merkezimizde yapilan cerrahi kardiyak miksoma rezeksiyonunun sonuclari bildirildi. Ca­lis­ma­pla­ni:­Ocak 1985 Aralik 2012 tarihleri arasinda miksoma tanisiyla ameliyat edilen 99 hasta (67 kadin, 32 erkek, ort. yas 49.8±16 yil; dagilim 5-76 yil) retrospektif olarak incelendi. Ameliyat oncesi tani transtorasik ekokardiyografi ile konuldu. Son takip vizitine kadar gecen ortalama sure 123.4±85.7 ay idi. Bul gu lar: Tum hastalar median sternotomi ile ameliyat edildi. Tumorun kokeni 92 hastada sol atriyum olup, en sik yerlesim yeri 85 hastada interatriyal septumdu. Bir hasta haric tum hastalarda total rezeksiyon yapildi. Kirk bes hastaya (%45.5) papiller miksoma, 54 hastaya (%54.5) solid miksoma tanisi konuldu. Embolik olay riski papiller tip miksomalarda, solid tipe kiyasla, anlamli oranda yuksek bulundu (%44.4’e kiyasla %9.3, p<0.01). Erken mortalite %5 idi. Tek degiskenli analiz sonuclarina gore ileri yas (p=0.04), ameliyat oncesi atriyal fibrilasyon varligi (p=0.02), periferik emboli (p=0.03) ve ameliyat sonrasi inotropik destek ihtiyaci (p=0.008) erken mortalite icin risk faktorleri olarak belirlendi. Bes, 10 ve 20 yillik aktueryal sagkalim oranlari sirasi ile %98, %94 ve %89 idi. Sagkalanlarda nuks orani %1.2 olarak tespit edildi. So­nuc:­Kardiyak miksoma cerrahisi, dusuk ameliyat riski tasimakla birlikte, mukemmel kisa ve uzun donem sonuclar ile iliskilendirilir. Ancak, uzun donemde dusuk nuks riskine ragmen, hastalar yillik ekokardiyografi ile takip edilmelidir. Anah tar soz cuk ler: Kardiyak tumor; miksoma; cerrahi; sagkalim. Background:­ In this study, we reported the outcomes of surgical resection of cardiac myxomas performed in our center. Methods: A retrospective review of 99 patients (67 females, 32 males, mean age 49.8±16 years; range 5 to 76 years) who were operated for myxoma between January 1985 and December 2012 was conducted. Preoperative diagnosis was established by transthoracic echocardiography. The mean time to the last follow-up visit was 123.4±85.7 months. Results:­ All patients were operated through median sternotomy. The site of origin of the tumor was left atrium in 92 patients and the most common implantion site was interatrial septum in 85 patients. A complete resection of the tumor was performed in all patients except one. Forty five patients (45.5%) were diagnosed with a papillary myxoma, while 54 patients (54.5%) were diagnosed with a solid myxoma. The risk of embolic events in papillary type of myxoma was significantly higher than the solid type (44.4% vs. 9.3%, p<0.01). Early mortality was 5%. Univariant analysis showed advanced age (p=0.04), preoperative presence of atrial fibrillation (p=0.02), peripheral embolism (p=0.03), and need for postoperative inotropic support (p=0.008) as the risk factors for early mortality. Actuarial survival rate was 98%, 94% and 89% at five, 10 and 20 years, respectively. The rate of recurrence was 1.2% in survivors. Conclusion:­Surgical treatment of cardiac myxoma carries a low operative risk and is associated with excellent short and long-term results. However, despite low risk of recurrence in the long-term, the patients should be followed with annual echocardiography.