Elbardissi Andrew W, Dearani Joseph A, Daly Richard C, Mullany Charles J, Orszulak Thomas A, Puga Francisco J, Schaff Hartzell V
Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Stroke. 2009 Jan;40(1):156-62. doi: 10.1161/STROKEAHA.108.525709. Epub 2008 Oct 23.
Embolic events have long been thought to occur in patients with cardiac tumors secondary to embolization of tumor fragments; however, there are no large studies examining the epidemiology and occurrence of embolism in this group of patients.
From 1957 to 2006, 323 consecutive patients with primary cardiac tumors were treated surgically at our institution. Of these, patients who experienced an embolic event included 80 (cerebrovascular accident 31 [9.7%], transient ischemic attack 30 [9.3%], and other 19 [6%]). Those with no history of an embolic event (n=243 [75%]) were defined as control subjects.
Age was similar between the case and control groups (mean 54.5 versus 53.9 years, P=0.8). A multivariate logistic regression model including tumor location, tumor burden, tumor histology, and cerebrovascular risk factors, indicated that left atrial tumors (OR, 1.95; P=0.04), aortic valve tumors (OR, 4.17; P=0.002), and smaller tumor burden (OR, 2.20; P=0.01) were the most significant factors in the occurrence of embolism (P<0.001). The presence of mitral regurgitation (OR, 0.12; P=0.006) and decreased functional status (New York Heart Association III/IV; OR, 0.31; P<0.001) were protective against the occurrence of embolism. Follow-up was obtained in 82% at a mean follow-up time of 6.17+/-6.9 years. There were no recurrent embolic events at follow-up. A Kaplan-Meier survival curve demonstrated no difference in survival between both groups (P=0.78).
Aortic valve and left atrial tumors have the greatest anatomic risk for embolism. Furthermore, patients with smaller tumors, minimal symptomatology, and no evidence of mitral regurgitation have a high risk of embolism. Cardiac tumors can be resected with low early mortality, and late survival after operation in the context of an embolic event is similar to patients with cardiac tumors who undergo resection for other indications.
