CC BY 4.0 · Surg J (N Y) 2018; 04(04): e176-e181
DOI: 10.1055/s-0038-1673333
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Two Decades of Contemporary Surgery of Primary Cardiac Tumors

Khalil Jawad
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Tamer Owais
2   Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany
Stefan Feder
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Sven Lehmann
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Martin Misfeld
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Jens Garbade
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Michael Borger
1   Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
› Author Affiliations
Source of Funding None.
Further Information

Publication History

31 March 2018

20 August 2018

Publication Date:
16 October 2018 (online)


Objective The decision to operate cardiac tumors is an issue of balancing surgical outcome and survival with quality of life (QOL). We report our single-center experience in managing primary cardiac tumors between 1994 and 2014.

Methods and Results In this study, 269 patients were subjected to our standardized operative protocols, preoperative preparations, postoperative follow-up, and consents of participation. Demographic and preoperative/intraoperative/postoperative variables were collected with focus on long-term follow-up and survival. A total of 72,000 cardiac procedures were performed within 20 years at our institution. Two hundred sixty-nine patients were diagnosed with primary cardiac tumors (0.37%), with a male:female ratio of 1:1.68, mean age of 57.4 ± 19.5 years, and body mass index of 25.49 ± 6.5. The most presenting symptoms were dyspnea (n = 94), arrhythmias (n = 53), embolic event (n = 36), and chest pain (n = 29), and 33 patients were accidentally discovered. Isolated tumor excision and concomitant ablation were performed on 181 patients, while the rest needed additional procedures such as coronary artery bypass grafting (n = 27) or valve surgery (n = 61). Focus on pathology, tumor location was done reporting the commonest pathology such as myxoma (n = 177) and fibroelastoma (n = 56). The frequent site was the left atrium (n = 162). Our primary results showed incidence of bleeding in 9 patients (3.3%), arrhythmias in 76 patients (28.25%), and mortality in 49 patients (18.2%). Five patients (1.8%) showed recurrence and 220 patients (81.8%) showed complaint-free survival.

Conclusion Complete excision of primary cardiac tumors is the golden rule in management as it improves survival and decreases morbidity expected from the progressing tumors process. The progression of minimally invasive techniques improves QOL and should be performed whenever possible.

  • References

  • 1 McAllister Jr HA, Fenoglio Jr JJ. Tumors of the cardiovascular system. In: Atlas of tumor pathology. Washington D.C.: Armed forces institute of pathology; 1978
  • 2 Crafoord C. Discussion on mitral stenosis and mitral insufficiency, e. Lam CR, Editor. Philadelphia: W.B. Saunders: Proceedings of the International Symposium on Cardiovascular Surgery Henry Ford Hospital, Detroit. p. 1955.202-11.11
  • 3 Habertheuer A, Laufer G, Wiedemann D. , et al. Primary cardiac tumors on the verge of oblivion: a European experience over 15 years. J Cardiothorac Surg 2015; 10: 56
  • 4 Meyns B, Vancleemput J, Flameng W, Daenen W. Surgery for cardiac myxoma. A 20-year experience with long-term follow-up. Eur J Cardiothorac Surg 1993; 7 (08) 437-440
  • 5 Actis Dato GM, De Benedictis M, Actis Dato Jr A, Ricci A, Sommariva L, De Paulis R. Long-term follow-up of cardiac myxomas (7-31 years). J Cardiovasc Surg (Torino) 1993; 34 (02) 141-143
  • 6 Habertheuer A, Ehrlich M, Wiedemann D, Mora B, Rath C, Kocher A. A rare case of primary cardiac B cell lymphoma. J Cardiothorac Surg 2014; 9: 14
  • 7 Dein JR, Frist WH, Stinson EB. , et al. Primary cardiac neoplasms. Early and late results of surgical treatment in 42 patients. J Thorac Cardiovasc Surg 1987; 93 (04) 502-511
  • 8 Obeid AI, Marvasti M, Parker F, Rosenberg J. Comparison of transthoracic and transesophageal echocardiography in diagnosis of left atrial myxoma. Am J Cardiol 1989; 63 (13) 1006-1008
  • 9 Jones DR, Warden HE, Murray GF. , et al. Biatrial approach to cardiac myxomas: a 30-year clinical experience. Ann Thorac Surg 1995; 59 (04) 851-855 , discussion 855–856
  • 10 Gerbode F, Kerth WJ, Hill JD. Surgical management of tumors of the heart. Surgery 1967; 61 (01) 94-101
  • 11 Attar S, Lee YC, Singleton R, Scherlis L, David R, McLaughlin JS. Cardiac myxoma. Ann Thorac Surg 1980; 29 (05) 397-405
  • 12 Melo J, Ahmad A, Chapman R, Wood J, Starr A. Primary tumors of the heart: a rewarding challenge. Am Surg 1979; 45 (11) 681-683
  • 13 Sellke FW, Lemmer Jr JH, Vandenberg BF, Ehrenhaft JL. Surgical treatment of cardiac myxomas: long-term results. Ann Thorac Surg 1990; 50 (04) 557-561
  • 14 Kabbani SS, Jokhadar M, Meada R. , et al. Atrial myxoma: report of 24 operations using the biatrial approach. Ann Thorac Surg 1994; 58 (02) 483-487 , discussion 487–488
  • 15 Marvasti MA, Obeid AI, Potts JL, Parker FB. Approach in the management of atrial myxoma with long-term follow-up. Ann Thorac Surg 1984; 38 (01) 53-58
  • 16 Poole Jr GV, Meredith JW, Breyer RH, Mills SA. Surgical implications in malignant cardiac disease. Ann Thorac Surg 1983; 36 (04) 484-491
  • 17 Elbardissi AW, Dearani JA, Daly RC. , et al. Survival after resection of primary cardiac tumors: a 48-year experience. Circulation 2008; 118 (14, Suppl): S7-S15