Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases
Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases
复制标题
心房粘液瘤患者手术干预后的远期结局：403例分析
DOI：
10.11909/j.issn.1671-5411.2019.04.003
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发表时间：
2019-01-01
影响因子：
2.5
通讯作者：
Yao, Yan
中科院分区：
文献类型：
--
作者：
Jiang, Chen-Xi;Wang, Jian-Gang;Yao, Yan
目的评价心房黏液瘤术后患者的长期生存率和晚期心血管事件。方法回顾性分析2002年1月至2016年12月行心房黏液瘤切除术的403例患者，中位随访时间为4.5年（0.5 ~ 15年）。结果交叉钳夹时间为41.1 +/- 21.4 min，体外循环次数为65.2 +/- 27.3 min。所有病例均经组织病理学证实为黏液瘤。早期住院死亡率为0.7% （n = 3）。随访期间，肿瘤复发6例，脑梗死9例。48例（11.9%）为晚发型房颤（AF）。多因素分析显示，年龄（HR = 1.05, 95% CI: 1.02-1.09, P < 0.001）、左房径（HR = 1.23, 95% CI: 1.08-1.36, P = 0.012）、二尖瓣手术（HR = 1.17, 95% CI: 1.05-1.29, P = 0.027）是晚发型房颤的独立预测因素。随访期间有21例（5.2%）患者死亡。高龄（HR = 1.07, 95% CI: 1.04-1.10, P = 0.003）和多次手术（HR = 1.18, 95% CI: 1.06-1.29, P = 0.012）与总死亡率显著相关。结论心房黏液瘤可手术切除，远期生存率高。晚发性房颤常见于心房黏液瘤术后。高龄、左心房内径和二尖瓣手术是预后的独立预测因素。
Objective To assess long-term survival and late cardiovascular events in patients with atrial myxoma after surgical intervention. Methods Retrospective analysis of 403 patients undergoing resection of atrial myxoma from January 2002 to December 2016 was conducted with a median follow-up period of 4.5 (range: 0.5-15) years. Results The cross-clamp time and cardiopulmonary bypass times were 41.1 +/- 21.4 and 65.2 +/- 27.3 min, respectively. A diagnosis of myxoma was histopathologically confirmed in all cases. The early in-hospital mortality rate was 0.7% (n = 3). During the follow-up period, tumor recurrence occurred in six patients and cerebral infarction in nine. There were 48 (11.9%) patients with late onset atrial fibrillation (AF). By multivariate analysis, age (HR = 1.05, 95% CI: 1.02-1.09, P < 0.001), left atrial diameter (HR = 1.23, 95% CI: 1.08-1.36, P = 0.012), and mitral valve surgery (HR = 1.17, 95% CI: 1.05-1.29, P = 0.027) were independent predictors of late onset AF. Twenty-one (5.2%) patients died during the follow-up period. Advanced age (HR = 1.07, 95% CI: 1.04-1.10, P = 0.003) and multiple surgical procedures (HR = 1.18, 95% CI: 1.06-1.29, P = 0.012) were significantly associated with overall mortality. Conclusions Atrial myxoma can be resected with good long-term survival. Late onset AF is common after surgery in patients with atrial myxoma. Advanced age, left atrial diameter, and mitral valve surgery were independent predictors of outcomes.