Predictors of Late Mortality in Patients With Surgically Resected Cardiac Myxomas: A Single-Center Experience

Raluca Tulin; Roxana Carmen Geana; Mircea Robu; Vlad Anton Iliescu; Ovidiu Stiru; Reza Nayyerani; Andreea Simina Chibulcutean; Nicolae Bacalbasa; Irina Balescu; Adrian Tulin; Luminita Tomescu

doi:10.7759/cureus.20866

Predictors of Late Mortality in Patients With Surgically Resected Cardiac Myxomas: A Single-Center Experience

Cureus. 2022 Jan 1;14(1):e20866. doi: 10.7759/cureus.20866. eCollection 2022 Jan.

Authors

Affiliations

¹ Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU.
² Endocrinology, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU.
³ Cardiac Surgery, C.C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, ROU.
⁴ Department of Cardio-Thoracic Pathology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU.
⁵ Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, ROU.
⁶ Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU.
⁷ Clinic of General Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU.
⁸ Anatomy, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU.
⁹ Radiology, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, ROU.

Abstract

Background and objective Myxomas are the most common cardiac tumors. This study aimed to analyze the possible risk factors associated with late mortality in this group of patients and assess long-term survival. Methods A retrospective study was conducted among patients who underwent myxomas resection between January 2008 and July 2019 in our service. The patients' preoperative, intraoperative, and postoperative data were analyzed. Multivariate logistic regression was performed to identify predictors of mortality at five years. The Kaplan-Meier curve and Cox proportion-adjusted survival curves were used to assess mortality at five and 10 years. Results A total of 108 patients with cardiac myxomas were identified. All cardiac tumors resected were confirmed as myxomas on histopathological examination. Ninety-six patients presented with left-side myxomas (94 left-atria and two left-ventricle) and 12 with right-side myxomas (11 right-atria, one right-ventricle); 78 of the tumors were capsulated, and 30 were sessile-papillary. The mean dimensions were 37 ±6.1 mm on the left side and 41 ±6.7 mm on the right side. Surgical excision was successful in all cases, with 25% requiring interatrial septum patch repair. Recurrence occurred in 2.77% of the patients. Multivariate logistic regression showed chronic kidney disease (CKD) (OR: 7.96, 95% CI: 1.469-43.125, p=0,016) to be an independent predictor for five-year mortality. The mean follow-up period was 7.13 ±2.965 years, and the Kaplan-Meier curve cumulative proportion survival of patients at five years and 10 years were 100% and 88.8%, respectively. There was no statistically significant difference in late-term survival between patients with and without CKD in the Cox proportion-adjusted survival curve (p=0.275). Conclusions Patients with myxomas have a good long-term prognosis following surgical resection. The multivariate logistic regression showed CKD to be an independent predictor of five-year mortality.

Keywords: cardiac myxomas; chronic kidney disease; long-term prognosis; mortality; predictor.