Abstract 14222: Surgery for Primary Cardiac Tumors in Children: Early and Late Results in a Multi-Center European Congenital Heart Surgeons Association (echsa) Study.
Objective: to evaluate early and long term results of surgical treatment of cardiac tumors in the pediatric age.
Materials and methods: a retrospective multicenter review of clinical and pathological data from 15 centers. Statistical analysis was performed using SPSS v.16.0.
Results: Eighty-nine patients younger than 18 years and operated on between 1990 and 2003 were included (M/F =41/48; median age 4.3 months, range 1 day-18 years). Sixty-three patients (70%) presented with symptoms. Bi-dimensional echocardiography outlined hemo-dynamical impairment in 74% of patients. Surgery consisted in complete resection in 62 patients (69.7%), partial resection in 22 (24.7%), cardiac transplant in 4 (4.5%), univentricular palliation in 1. Most frequent types of tumor were rhabdomyoma (38%), myxoma (20%) and fibroma (11%). Six patients had a malignant mass (7%). Post-operative complications occurred in 24 patients (27.6%). Hospital mortality was 4.5% (4 patients, 2 of whom had a malignant mass). At a mean follow up of 6.2 ± 4.4 years (follow up completeness: 95%), 94% of patients are in NYHA class I, 84% have functional capacity comparable to peers, while 16% have neurological underdevelopment related to tuberous sclerosis. late mortality was 4.5%. Major adverse events occurred in 28% of patients. Cardiac tumor recurred in 4 patients (5%), a non cardiac neoplasm occurred in 4 (5%). There were no differences in survival, post-operative complications or adverse events related to surgical technique (complete vs partial resection). Cardiac transplant correlated with greater mortality (p = 0.046, OR = 12.00) and greater incidence of post-operative complications (p = 0.062, OR = 8.86) and adverse events (0.066, OR = 8.68) at follow up. Overall mortality was related to malignancy (p value 0.006, OR 20.7), onset of symptoms at presentation (p = 0.036, OR = 1.57) and incidence of adverse events during follow up (p = 0.014, OR = 4.60).
Conclusions: rhabdomyomas and myxomas are the most frequent subtypes. Conservative surgery is safe, with excellent late term outcome. Malignancy affects early and late results. Recurrence of cardiac neoplasm is low. Heart transplant has suboptimal early and late outcomes
- © 2010 by American Heart Association, Inc.