Postoperative Course and Long-Term Results after Primary Malignant Heart Tumor Resection: A Single-Center Experience

Objectives: The frequency of primary malignant cardiac tumors is often characterized by results of autopsy series since they rarely occur in clinical care.

Methods: From May 1991 to May 2014 28 patients underwent surgical treatment of a primary malignant cardiac tumor in our center. We analyzed our clinical database retrospectively for information on patient characteristics, perioperative and postoperative treatment data as well as information about complications of the surgical procedure. The follow-up could be completed to 92.9%.

Results: Radical tumor R0 resection was achieved in most cases. The mean (±SD) duration of hospital stay from admission to discharge or death was 24 days (±19.6). The mean follow-up period was 37.2 months (±75.1). 67.9% of patients (n = 19) were dead by the time of follow-up. Postoperative mortality within the first 30 days was 19.2% (n = 5). In 4 of these 5 cases, postoperative low-output left heart failure was the leading cause of death. The cumulative survival rate after one month accounted for 80.8%, after 3 months 69.2%, after 6 months 53.8%, after 12 months 49.7% and after 24 months 28.0%. The mean survival time in the whole group was 70.8 months. Tumor resection had to be repeated due to tumor relapse in four cases, in which all these patients suffered from cardiac sarcoma. Tumor resection could be performed without 30 days mortality in three cases. A low tumor differentiation was associated with low mean survival. G3 tumors (n = 12) had a mean survival of 8.1 months. The group of G1 or G2 tumors (n = 8) led to a mean survival of 59.3 months, however, this difference was not statistically significant. There was no significant survival difference regarding the adjuvant therapy concept.

Conclusion: In the case of malignant tumors, extended surgery alone or in combination with chemo- and / or radiotherapy may be successful in certain cases and may offer a satisfactory quality of life. But this study also implies the limitation of retrospective data analysis. The patient sample is acquired by data of more than two decades thus leading to difficulties in retrospective data collection. Furthermore the low number of cases is a general challenge in the case of primary malignant cardiac tumor research. Therefore the establishment of a Multicenter Heart Tumor Register in Germany is necessary to increase the number of cases in studies, get more remarkable study results and standardize the diagnosis and therapy.