Surgical Resection of Benign Primary Cardiac Tumors: a Six-Decade Evaluation of Survival and Recurrence

A. Bernabei¹, A. Toth¹, M. Gillinov², E. H. Blackstone¹, M. B.. Komarovsky³, J. H. K.. Chen³, P. Chin⁴, D. Burns¹, E. E.. Roselli^1
1Cleveland Clinic, Cleveland, Ohio ²The Cleveland Clinic, Cleveland, Ohio ³Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio ⁴Case Western Reserve University School of Medicine, Cleveland, Ohio

Purpose: Primary cardiac tumors are rare. Most (> 90%) are benign and have good prognoses. Still, they carry potential hemodynamic or arrhythmic consequences, and surgical resection remains the preferred treatment. We report early and late survival and recurrence after resection of benign tumors over six decades at our institution.

Methods: From 01/01/1965 to 12/31/2022, 563 patients underwent surgical resection of benign primary cardiac tumors at our institution. Common benign tumors included myxoma (n=351/62%) and papillary fibroelastoma (n=167/30%), and rare ones included lipoma (n=16/2.8%), paraganglioma (n=10/1.8%), fibroma (n=5/0.9%), and hemangioma (n=5/0.9%). Diagnosis was confirmed in all by histopathology. Clinical data were retrieved from prospective quality registries with additional information extracted from medical records and follow-up surveys. Median follow-up was 4.5 years; 25% were followed >12 years. Use of these data for research was approved by the Institutional Review Board, with waiver of consent.

Results: Intracardiac tumors were left-sided in 322 myxomas (92%), 133 papillary fibroelastomas (81%), and 23 rare benign tumors (56%) (Table). Most myxomas were in the left atrium (n=313/89%); papillary fibroelastomas were commonly found on the aortic valve (n=64/38%) in the left atrium (n=34/20%) and left ventricle (n=31/19%). Rare tumors were in the right atrium (n=13/29%), left atrium (n=11/24%), left ventricle (n=11/24%), and right ventricle (n=8/18%). Figure A shows the prevalence of cardiac tumors over time. During follow-up, 166 patients died. Survival at six months, 1, 5, 10, 15, 20, and 25 years was 97%, 96%, 88%, 73%, 59%%, 46%, and 36%, respectively. Patients with cardiac myxomas had better survival than other groups (P <.0001), with survival similar to that of the general US population (Figure B). Two tumors recurred during follow-up, both left atrial myxomas. One patient with Carney complex developed multiple cardiac masses. Five new strokes (n=2 myxomas, n=3 fibroelastomas) occurred during follow-up.

Conclusion: Outcomes of benign primary cardiac tumor resections are excellent in both short- and long-term. After undergoing resection of a benign cardiac tumor, most patients can be considered "cured."

Identify the source of the funding for this research project: None