Surgical management of cardiac myxomas in elderly patients

Abstract

Objective: Cardiac myxoma usually presents during early adulthood. There is generally a tendency for prompt surgical resection. However, advanced age of patients presenting with this disease may increase the operative risk due to other cardiac and non-cardiac problems. Therefore, we evaluated elderly patients who underwent surgery for myxoma to review the management of treatment. Methods:Between September 1985 and March 2012, a total of 17 consecutive patients over 65 years of age (5 male, 12 female; mean age: 69.3±3.5 years) who had undergone surgical resection for cardiac myxoma were analyzed retrospectively. Echocardiography had been performed in all patients to diagnose the myxoma and evaluate other cardiac pathologies. Coronary angiography had been performed in all patients except in two cases who underwent emergency surgery.Results: Thirteen patients (76.4%) survived the operation. Two patients who underwent emergency operation died early and four patients died during the follow-up time. Concomitant procedures included coronary artery bypass grafting in two, radiofrequency ablation in one, mitral valve reconstruction in one and femoral embolectomy in one patient. Conclusions:In an era of aging population, myxoma tends to be diagnosed more frequently in elderly and high-risk patients. Complete preoperative assessment of these patients is a more appropriate approach in stable patients than the traditional emergency surgery applied to all cases.Keywords: Coronary angiography, echocardiography, myxoma, older age ÖZET İleri yaş hastalarda kardiyak miksomanın cerrahi tedavisiAmaç: Kardiyak miksoma genellikle erken erişkinlikte ortaya çıkar ve tanı sonrası hızlı bir şekilde cerrahi rezeksiyon yapılmaya eğilim vardır. Bununla beraber, daha ileri yaşlarda bu hastalığa maruz kalan hastalarda, cerrahi risk eşlik eden diğer kardiyak ve non-kardiyak rahatsızlıklardan dolayı daha yüksek olabilir.Bu nedenle, kardiyak miksoma nedeniyle cerrahi rezeksiyon yapılan yaşlı hastalarımızı, tedavi yönetimle-rini gözden geçirmek için değerlendirdik.Yöntemler: Eylül 1985-Mart 2012 arasında kardiyak miksoma nedeniyle ameliyat edilen 65 yaş üzerindeki ardışık 17 hasta (5 erkek, 12 kadın; ortalama yaş, 69.3±3.5 yıl) retrospektif olarak analiz edildi. Tüm hastalara miksoma tanısı ve diğer kardiyak defektlerin saptanması için ekokardiyografi yapıldı. Acil olarak opere edilen iki hasta dışında tüm hastalara koroner anjiyografi yapıldı. En çok gözlenen semptom dispneydi (%70.5), atriyal fibrilasyon 5 hastada gözlendi (%29.4). Sistemik embolizasyon 7 hastada vardı (%41.1). Tüm tümörler sol atriyumdan köken almışlardı. Bulgular:Operasyon sonrası hayatta kalan hasta sayısı 13 (%76.4) idi. Acil olarak operasyona alınan iki hasta da erken dönemde kaybedildi. Takip esnasında 4 hasta kaybedildi. Eş zamanlı olarak iki hastaya koroner arter baypas cerrahisi, 1 hastaya radyofrekans ablasyon, 1 hastaya mitral kapak onarımı ve 1 hastaya da femoral embolektomi yapıldı.Sonuç: Yaşlanan toplumda, miksomanın daha yaşlı ve yüksek riskli hastalarda ...

Asymptomatic Pulmonic Valve Mass: A Diagnostic and Therapeutic Dilemma

“…With increasing life expectancy, however, the incidence of myxomas is rising in the elderly, creating challenges for surgical treatment [ 8 , 15 ]. A recent study reported about 25% mortality in the geriatric population undergoing cardiac surgery with a mean age of ~69±4 years at the time of surgery [ 16 ]. There have been reports of no surgical intervention, but the literature is silent about non-surgical management, follow-up, and prognosis in these patients.…”

Asymptomatic left atrial myxoma

“…[ 2 4 8 ] In elderly patients with comorbidities, surgery is associated with a significantly increased risk of death of up to 23.5%. [ 9 ]…”

Medical management of a suspected atrial myxoma in a nonagenarian

“…24 With respect to geriatric patients, a recent study evaluated elective surgery in elderly patients with myxomas. 15 During the time frame, 1985-2012, 17 consecutive patients (mean age ~69 ± 4 years) were evaluated. Overall, 13 patients survived resection with a relatively high mortality rate of nearly 25%.…”

“… 14 Our patient had atrial fibrillation, which was coincident in almost 30% of patients. 5 , 15 The emergence of heart failure is contingent on tumor location and burden in creating a pseudo-stenotic effect due to malapposition of mitral valve leaflets and obstructive physiology within the left ventricular outflow tract. 16 Also, it has been postulated that a paraneoplastic cytokine milieu may induce myocardial inflammation and resultant ischemia.…”