From the Guidelines
Surgical excision is the recommended treatment for cardiac myxomas, as it is the most effective way to prevent embolization, cardiac obstruction, and sudden death. Myxomas are benign tumors most commonly found in the heart, particularly in the left atrium, and about 30% to 40% of them embolize, which can lead to ischemic stroke 1. The surgery involves a median sternotomy, cardiopulmonary bypass, and complete removal of the tumor along with a margin of normal tissue to prevent recurrence.
Key Points to Consider
- The risk of embolization is high, even in asymptomatic patients, making prompt surgical excision necessary 1.
- Post-surgery, patients typically require 4-6 weeks for recovery and should undergo regular echocardiographic follow-up (usually annually) to monitor for recurrence 1.
- There is no effective medical therapy or chemotherapy for myxomas, making surgical removal the only viable treatment option 1.
- The prognosis after complete surgical removal is excellent, with most patients returning to normal life without restrictions 1.
Treatment Approach
The treatment approach for cardiac myxomas should prioritize surgical excision, as it is the most effective way to prevent complications and ensure a favorable outcome. The American Heart Association recommends surgical excision for the treatment of atrial myxomas 1.
Outcome
The outcome of surgical excision for cardiac myxomas is generally excellent, with low recurrence rates and minimal complications. Regular follow-up and monitoring are necessary to ensure the best possible outcome 1.
From the Research
Treatment Overview
- The primary treatment for cardiac myxoma is surgical removal 2, 3, 4, 5, 6.
- Surgical excision is considered curative, with few recurrences at long-term follow-up 2, 3.
Surgical Approaches
- Various surgical approaches can be used, including conventional median sternotomy, minimally invasive, and robotic-assisted approaches 5.
- The choice of surgical technique should be individualized based on tumor size, location, patient condition, and surgeon expertise 5.
- Biatrial approach is preferred for left atrial myxomas, providing wider exposure and better outcomes 6.
Outcomes and Complications
- Surgical excision of cardiac myxoma carries a low operative risk and gives excellent short-term and long-term results 2, 3.
- Postoperative survival is similar to that of an age- and sex-matched population, with 94% of patients free of recurrent myxomas at 20 years postoperatively 3.
- Complications can include embolic events, obstruction of the mitral orifice, and low cardiac output syndrome 2, 6.