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Xiong S, Song L, Li G, Li J. What Influences the Patients with Left Atrial Myxoma: From Embolism to Postoperative Atrial Fibrillation. World J Surg 2020; 44:3943-3951. [PMID: 32613341 DOI: 10.1007/s00268-020-05665-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Preoperative embolism and postoperative atrial fibrillation (POAF) are two important factors associated with impaired health conditions and increased economic burden in patients with left atrial (LA) myxoma. The aim of this study was to analyze embolic events, identify predictors of POAF, and evaluate the risk of late-term survival in patients with LA myxoma. METHODS From December 2009 to December 2019, 177 consecutive patients with LA myxoma who met the selection criteria were included in the retrospective analysis. Multivariate logistic regression analysis was performed to identify predictors of POAF. Propensity score matching was used for confounder control, and Cox proportional hazards models were used to evaluate the risk of late-term mortality. RESULTS The study population comprised of 125 patients in non-POAF group and 52 patients in POAF group. Preoperative embolism was present in 27.1% of the all cases. By multivariate analysis, age, NYHA functional class III, LA diameter, and cross-clamp time were identified as independent predictors of in-hospital POAF. The overall survival at 1, 5, and 10 years for the 177 patients was 98.9%, 93.7%, and 84.4%, respectively. There was no statistical difference in late-term survival between the two groups in the Cox proportion-adjusted survival curve. After propensity score 1:1 matching, patients with POAF had a longer postoperative hospital stay and Kaplan-Meier survival curve also showed no statistical difference between the two groups. CONCLUSIONS Patients with LA myxoma after surgical treatment had a favorable prognosis. In-hospital POAF was not independently associated with late-term mortality in patients with LA myxoma.
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Affiliation(s)
- Sizheng Xiong
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430000, China
| | - Lihui Song
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430000, China
| | - Gen Li
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430000, China
| | - Jun Li
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430000, China.
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Rahouma M, Arisha MJ, Elmously A, El-Sayed Ahmed MM, Spadaccio C, Mehta K, Baudo M, Kamel M, Mansor E, Ruan Y, Morsi M, Shmushkevich S, Eldessouki I, Rahouma M, Mohamed A, Gambardella I, Girardi L, Gaudino M. Cardiac tumors prevalence and mortality: A systematic review and meta-analysis. Int J Surg 2020; 76:178-189. [PMID: 32169566 DOI: 10.1016/j.ijsu.2020.02.039] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Cardiac tumors and their associated outcomes are poorly characterized. This study sought to comprehensively assess the epidemiology and natural history of primary and secondary malignant cardiac tumors (PMCT and SMCT), a well as establish predictors of mortality. METHODS A comprehensive literature review was performed to identify articles reporting on PMCTs and SMCTs. The prevalence of important cardiac tumor (CT) subtypes was evaluated and further stratified based on the continental region. Outcomes of interest included short- and long-term mortality and utilization of heart transplantation (HTX). A random effect model was adopted, and a meta-regression was performed to determine predictors of the prevalence of CTs as well as predictors of operative mortality. RESULTS Of the 1,226 retrieved articles, 74 were included in our study (n = 8,849 patients). The mean follow-up was 2.27 years, mean age was 42.9 years, and 55% of the patients were females. There was a total number of 7,484 benign primary cardiac tumors (PCTs) (5,140 were myxoma), 862 (9.7%) malignant PCTs, and 355 secondary cardiac tumors. The prevalence of PMCTs among PCTs was 10.83% [95%CI = 09.11; 12.83%] with a trend towards being lower in South America compared to other continents (Prevalence = 5.80%). The prevalence of HTX among all patients was 2.45% [1.36; 4.38%]. The pooled short-term mortality was 5.90% [4.70; 7.39%] and the incidence of late mortality in all CTs, benign CT and PMCTs was 2.55% [1.76; 3.72%], 0.79% [0.46; 1.37%] and 14.77% [9.32; 23.40%], respectively. On meta-regression, the annual volume of cardiac tumor cases per center was the only predictor of lower early mortality (Beta = -0.14 ± 0.03, P < 0.0001). CONCLUSIONS PMCTs represent the minority of PCT (~10%) and have a higher prevalence in Europe and North America. Survival is higher in benign pathology and is significantly improved by treatment in specialized high-volume centers. Approximately 2% of patients with CTs undergo heart transplantation.
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Affiliation(s)
- Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt.
| | - Mohammed J Arisha
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Adham Elmously
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | | | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank, Glasgow, G814DY, UK; Institute of Cardiovascular and Medical Sciences, Veterinary and Life Sciences, College of Medical, University of Glasgow, Glasgow, G128QQ, UK
| | - Kritika Mehta
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Massimo Baudo
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mohamed Kamel
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA; Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Esraa Mansor
- Internal Medicine Department, West Virginia University Charleston Division, Charleston Area Medical Center, Charleston, WV, USA
| | - Yongle Ruan
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mahmoud Morsi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Shon Shmushkevich
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Ihab Eldessouki
- Medical Oncology Department, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Mostafa Rahouma
- Information Technology Department, National Cancer Institute, Cairo University, Egypt
| | - Abdelrahamn Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Egypt
| | - Ivancarmine Gambardella
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Leonard Girardi
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
| | - Mario Gaudino
- Cardiothoracic Surgery Department, Weill Cornell Medicine/New York Presbyterian Hospital, New York, USA
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Wan Y, Du H, Zhang L, Guo S, Xu L, Li Y, He H, Zhou L, Chen Y, Mao L, Jin H, Hu B. Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report. BMC Neurol 2019; 19:249. [PMID: 31646971 PMCID: PMC6813067 DOI: 10.1186/s12883-019-1474-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022] Open
Abstract
Background Cardiac myxoma is the most common benign cardiac tumor. Brain metastases or multiple cerebral aneurysms are extremely rare, especially for the case of both complications. Brain metastases are usually found at the same time or few months after the diagnosis or surgical removal of cardiac myxoma Case presentation We describe a case of patient, operated for a cardiac myxoma, who presented multiple central nervous system metastases associated, cerebral aneurysms and subsequent intracerebral hemorrhage Conclusions The long-term follow-up of the patients with atrial myxoma even after complete surgical excision is recommended, especially for the patient with central nervous system manifestations before atrial myxoma excision
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Affiliation(s)
- Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hai Du
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Neurology, Caidian People Hospital, Wuhan, 430100, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuang Guo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li Xu
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, China
| | - Yuanyuan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lian Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunping Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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