title: Risk prediction for emboli and recurrence of primary cardiac myxomas after resection.
abstract: BACKGROUND
  Risk factors for embolism and recurrence of primary cardiac myxoma are not well established. This study aimed to assess the risk factors for embolism and recurrence of cardiac myxoma, as well as the survival of the patients.
  
  
  METHODS
  The medical records of 207 consecutive patients treated for primary cardiac myxoma between September 1988 and October 2014 were retrospectively analyzed. All diagnoses were pathologically confirmed. Data were collected to identify the risk factors influencing the prognosis.
  
  
  RESULTS
  Mean age at surgery was 44.2 ± 15.8 years. Operative mortality (within 30 days of the surgery) occurred in seven patients. Mean follow-up was 9.35 ± 6.55 years. Embolism occurred in 32 (15.5 %) patients before surgery. Multivariate analysis indicated that small (≤ 4.5 cm) myxoma (OR = 5.14; 95 % CI, 2.30-11.94; P < 0.0001) and soft, gelatinous myxoma (OR = 5.84; 95 % CI, 1.91-25.61; P = 0.001) were independently associated with the occurrence of embolism. Ten patients experienced recurrences. After excluding the patients who died within 30 days of surgery, survival was 92.7 % at 10 years. Age, sex, tumor size, cardiopulmonary bypass duration, aortic cross clamp duration, tumor appearance, and pre-operative embolism were not associated with early mortality. Multivariate analysis showed that multicentric myxomas were independently associated with recurrence (OR = 9.45, 95 % CI, 2.15-41.3, P = 0.004).
  
  
  CONCLUSIONS
  The surgical resection of primary cardiac myxoma is associated with excellent long-term survival. Tumors ≤ 4.5 cm and soft tumors were independent risk factors for embolism. Multicentric cardiac myxoma was an independent risk factors for recurrence of myxoma.
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. zhjwang512@sina.com.
authors.forename: Zhengjun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Coronary Care Unit, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. xiaoqiaoccu@163.com.
authors.forename: Shiqiao
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Ultrasound, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. amy_echo@126.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. zlonglong@vip.sina.com.
authors.forename: Wenlong
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. zhz_doctor@163.com.
authors.forename: Haizhou
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. hongxinli@hotmail.com.
authors.forename: Hongxin
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. wangzhj512@sohu.com.
authors.forename: Guidao
authors.initials: G
authors.lastname: Yuan
authors.affiliation: Department of Cardiovascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, Shandong Province, China. cwzoucardiac@sina.com.
authors.forename: Chengwei
authors.initials: C
authors.lastname: Zou
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004617:Embolism / Q000209:etiology*; D005260:Female; D006338:Heart Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009232:Myxoma / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
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