Surgical experience with 77 primary cardiac tumors.

Background: To assess the prognosis and to develop management strategies for primary cardiac tumors all patients were included in an ongoing study.

Method: From Oct. 1994 until December 2003 we prospectively evaluated all patients with cardiac tumors. Follow up examinations were performed every 12 months.

Results: There were a total of 77 primary cardiac tumors. Seventy-three were benign: myxoma (n=59), papillary fibroelastoma (n=11), lipoma (n=2), fibroma (n=1) and four malignant sarcoma (n=4). The myxoma group consisted of 19 males and 40 females aged 12 to 88 years. Myxomas were located in the: left atrium in 50 (85%), left ventricle in 3 (5%), right atrium in 4 (7%) and on the mitral valve in 2 patients (3%). Papillary fibroelastoma was located on the aortic valve (n=4), mitral valve (n=3), right ventricle (n=2), left ventricle (n=1) and tricuspid valve (n=1). Both lipoma and the only fibroma were located in the right atrium. There were 4 primary cardiac sarcomas, located in the right ventricle (n=2), the pulmonary valve (n=1) and left atrium (n=1). Minimal invasive right thoracotomy was utilized in 19 of 73 patients all with benign tumor. There were two early deaths (3%): a myxoma patient with triple vessel disease and a LVEF less than 30% and one sarcoma patient. No recurrence or late death was observed in the group of benign tumors. However, two remaining patients with sarcoma had recurrent disease 10 and 15 month later, respectively. All patients were followed up with a total follow up of 203 patient years.

Conclusion: Surgical excision of benign cardiac tumors is a safe and curative treatment, which is feasible using minimally invasive right thoracotomy approach and provides excellent results. However, therapy of malignant cardiac tumors continues to have a poor prognosis despite individualization of approach.