Survival after resection of primary cardiac tumors: a 48-year experience
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. From 1957 to 2006, 323 consecutive pat...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2008-09, Vol.118 (14 Suppl), p.S7-15 |
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| creator | Elbardissi, Andrew W Dearani, Joseph A Daly, Richard C Mullany, Charles J Orszulak, Thomas A Puga, Francisco J Schaff, Hartzell V |
| description | 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.
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 |
| doi_str_mv | 10.1161/CIRCULATIONAHA.107.783126 |
| format | Article |
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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.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.107.783126</identifier><identifier>PMID: 18824772</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Age Distribution ; Aged ; Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - mortality ; Cardiac Surgical Procedures - statistics & numerical data ; Cardiopulmonary Bypass ; Female ; Fibroma - mortality ; Fibroma - surgery ; Heart Neoplasms - diagnosis ; Heart Neoplasms - mortality ; Heart Neoplasms - pathology ; Heart Neoplasms - surgery ; Humans ; Incidence ; Kaplan-Meier Estimate ; Lipoma - mortality ; Lipoma - surgery ; Male ; Middle Aged ; Multivariate Analysis ; Myxoma - mortality ; Myxoma - surgery ; Neoplasm Recurrence, Local - epidemiology ; Neoplasm Recurrence, Local - etiology ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Sex Distribution ; Time Factors</subject><ispartof>Circulation (New York, N.Y.), 2008-09, Vol.118 (14 Suppl), p.S7-15</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c364t-ec591d8b03ffdcf4f88cf48abbe306274aaa7a0a27ec3195bd540e4844a0d4113</citedby><cites>FETCH-LOGICAL-c364t-ec591d8b03ffdcf4f88cf48abbe306274aaa7a0a27ec3195bd540e4844a0d4113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18824772$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elbardissi, Andrew W</creatorcontrib><creatorcontrib>Dearani, Joseph A</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Mullany, Charles J</creatorcontrib><creatorcontrib>Orszulak, Thomas A</creatorcontrib><creatorcontrib>Puga, Francisco J</creatorcontrib><creatorcontrib>Schaff, Hartzell V</creatorcontrib><title>Survival after resection of primary cardiac tumors: a 48-year experience</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>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.
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.
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.</description><subject>Adult</subject><subject>Age Distribution</subject><subject>Aged</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Cardiac Surgical Procedures - statistics & numerical data</subject><subject>Cardiopulmonary Bypass</subject><subject>Female</subject><subject>Fibroma - mortality</subject><subject>Fibroma - surgery</subject><subject>Heart Neoplasms - diagnosis</subject><subject>Heart Neoplasms - mortality</subject><subject>Heart Neoplasms - pathology</subject><subject>Heart Neoplasms - surgery</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Lipoma - mortality</subject><subject>Lipoma - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myxoma - mortality</subject><subject>Myxoma - surgery</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Neoplasm Recurrence, Local - etiology</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Sex Distribution</subject><subject>Time Factors</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkE9Lw0AQxRdRbK1-BVkv3lL3X7IbbyWoLRQL2p7DZDMLkaSpu4nYb2-kAfEywwzvzWN-hNxxNuc84Q_Z6i3brRfb1eZ1sVzMOdNzbSQXyRmZ8lioSMUyPSdTxlgaaSnEhFyF8DGMidTxJZlwY4TSWkzJ8r33X9UX1BRch556DGi7qt3T1tGDrxrwR2rBlxVY2vVN68MjBapMdETwFL8P6CvcW7wmFw7qgDdjn5Hd89M2W0brzcsqW6wjKxPVRWjjlJemYNK50jrljBmqgaJAyRKhFQBoYCA0WsnTuChjxVAZpYCVinM5I_enuwfffvYYurypgsW6hj22fciTNOFSGDYI05PQ-jYEjy4f38k5y38x5v8xDmudnzAO3tsxpC8aLP-cIzf5AxepcEk</recordid><startdate>20080930</startdate><enddate>20080930</enddate><creator>Elbardissi, Andrew W</creator><creator>Dearani, Joseph A</creator><creator>Daly, Richard C</creator><creator>Mullany, Charles J</creator><creator>Orszulak, Thomas A</creator><creator>Puga, Francisco J</creator><creator>Schaff, Hartzell V</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080930</creationdate><title>Survival after resection of primary cardiac tumors: a 48-year experience</title><author>Elbardissi, Andrew W ; Dearani, Joseph A ; Daly, Richard C ; Mullany, Charles J ; Orszulak, Thomas A ; Puga, Francisco J ; Schaff, Hartzell V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c364t-ec591d8b03ffdcf4f88cf48abbe306274aaa7a0a27ec3195bd540e4844a0d4113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Age Distribution</topic><topic>Aged</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Cardiac Surgical Procedures - statistics & numerical data</topic><topic>Cardiopulmonary Bypass</topic><topic>Female</topic><topic>Fibroma - mortality</topic><topic>Fibroma - surgery</topic><topic>Heart Neoplasms - diagnosis</topic><topic>Heart Neoplasms - mortality</topic><topic>Heart Neoplasms - pathology</topic><topic>Heart Neoplasms - surgery</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Lipoma - mortality</topic><topic>Lipoma - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myxoma - mortality</topic><topic>Myxoma - surgery</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Neoplasm Recurrence, Local - etiology</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Sex Distribution</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elbardissi, Andrew W</creatorcontrib><creatorcontrib>Dearani, Joseph A</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Mullany, Charles J</creatorcontrib><creatorcontrib>Orszulak, Thomas A</creatorcontrib><creatorcontrib>Puga, Francisco J</creatorcontrib><creatorcontrib>Schaff, Hartzell V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elbardissi, Andrew W</au><au>Dearani, Joseph A</au><au>Daly, Richard C</au><au>Mullany, Charles J</au><au>Orszulak, Thomas A</au><au>Puga, Francisco J</au><au>Schaff, Hartzell V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Survival after resection of primary cardiac tumors: a 48-year experience</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2008-09-30</date><risdate>2008</risdate><volume>118</volume><issue>14 Suppl</issue><spage>S7</spage><epage>15</epage><pages>S7-15</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>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.
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.
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.</abstract><cop>United States</cop><pmid>18824772</pmid><doi>10.1161/CIRCULATIONAHA.107.783126</doi></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Age Distribution Aged Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Cardiac Surgical Procedures - statistics & numerical data Cardiopulmonary Bypass Female Fibroma - mortality Fibroma - surgery Heart Neoplasms - diagnosis Heart Neoplasms - mortality Heart Neoplasms - pathology Heart Neoplasms - surgery Humans Incidence Kaplan-Meier Estimate Lipoma - mortality Lipoma - surgery Male Middle Aged Multivariate Analysis Myxoma - mortality Myxoma - surgery Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - etiology Proportional Hazards Models Risk Assessment Risk Factors Severity of Illness Index Sex Distribution Time Factors |
| title | Survival after resection of primary cardiac tumors: a 48-year experience |
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