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. 2016 Feb 2:11:22.
doi: 10.1186/s13019-016-0420-4.

Risk prediction for emboli and recurrence of primary cardiac myxomas after resection

Zhengjun Wang  1 , Shiqiao Chen  2 , Mei Zhu  3 , Wenlong Zhang  4 , Haizhou Zhang  5 , Hongxin Li  6 , Guidao Yuan  7 , Chengwei Zou  8
Affiliations

Risk prediction for emboli and recurrence of primary cardiac myxomas after resection

Zhengjun Wang et al. J Cardiothorac Surg. .

Abstract

Background: Risk factors for embolism and recurrence of primary cardiac myxoma are not well established. This study aimed to assess the risk factors for embolism and recurrence of cardiac myxoma, as well as the survival of the patients.

Methods: The medical records of 207 consecutive patients treated for primary cardiac myxoma between September 1988 and October 2014 were retrospectively analyzed. All diagnoses were pathologically confirmed. Data were collected to identify the risk factors influencing the prognosis.

Results: Mean age at surgery was 44.2 ± 15.8 years. Operative mortality (within 30 days of the surgery) occurred in seven patients. Mean follow-up was 9.35 ± 6.55 years. Embolism occurred in 32 (15.5 %) patients before surgery. Multivariate analysis indicated that small (≤ 4.5 cm) myxoma (OR = 5.14; 95 % CI, 2.30-11.94; P < 0.0001) and soft, gelatinous myxoma (OR = 5.84; 95 % CI, 1.91-25.61; P = 0.001) were independently associated with the occurrence of embolism. Ten patients experienced recurrences. After excluding the patients who died within 30 days of surgery, survival was 92.7 % at 10 years. Age, sex, tumor size, cardiopulmonary bypass duration, aortic cross clamp duration, tumor appearance, and pre-operative embolism were not associated with early mortality. Multivariate analysis showed that multicentric myxomas were independently associated with recurrence (OR = 9.45, 95 % CI, 2.15-41.3, P = 0.004).

Conclusions: The surgical resection of primary cardiac myxoma is associated with excellent long-term survival. Tumors ≤ 4.5 cm and soft tumors were independent risk factors for embolism. Multicentric cardiac myxoma was an independent risk factors for recurrence of myxoma.

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Figures

Fig. 1
Fig. 1
Patient flow chart. The diagram shows patient distribution from enrolment to subgrouping of the included study subjects. Of the 7 cases with multicentric cardiac myxoma, 5 and 2 underwent right atriotomy and transseptal route and right atriotomy, respectively
Fig. 2
Fig. 2
Receiver operating characteristic curve for embolism. The area under the curve was 0.808
Fig. 3
Fig. 3
Cumulative incidence of tumor recurrence
Fig. 4
Fig. 4
Kaplan-Meier estimate of the survival of patients after surgical resection of their cardiac myxoma
See this image and copyright information in PMC

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