Outcomes after resection of primary cardiac sarcomaCentral MessagePerspective
Saad M. Hasan, MD,
James Witten, MD,
Patrick Collier, MD, PhD,
Michael Z. Tong, MD, MBA,
Gosta B. Pettersson, MD, PhD,
Nicholas G. Smedira, MD, MBA,
Andrew Toth, MS,
Dale Shepard, MD,
Eugene H. Blackstone, MD,
Eric E. Roselli, MD
Affiliations
Saad M. Hasan, MD
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
James Witten, MD
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Patrick Collier, MD, PhD
Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Michael Z. Tong, MD, MBA
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Gosta B. Pettersson, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Nicholas G. Smedira, MD, MBA
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Andrew Toth, MS
Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
Dale Shepard, MD
Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Hematology and Oncology, Oncology Institute, Cleveland Clinic, Cleveland, Ohio
Eugene H. Blackstone, MD
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
Eric E. Roselli, MD
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Cardio-Oncology Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Address for reprints: Eric E. Roselli, MD, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195-5108.
Objective: To evaluate the outcomes of surgical resection of malignant primary cardiovascular tumors. Methods: From 1983 to 2018, 32 patients underwent surgical resection of malignant primary cardiovascular sarcoma at Cleveland Clinic. Mean age was 48 ± 15 years, and 19 (59%) were women. Outcomes are compared between those with complete resection and those without, and in relation to primary location. Results: The most common histologic subtypes were angiosarcoma (n = 8 [25%]) and high-grade undifferentiated sarcoma (n = 7 [22%]). Fourteen (44%) involved the left heart, 9 (28%) the right heart, 8 (25%) the pulmonary arteries, and 1 (3%) the aorta. There was clinical evidence of isolated extracardiac metastases in 8 (25%). Six (19%) patients were deemed unresectable at surgery, undergoing biopsy and palliative debulking followed by referral for definitive chemotherapy and/or radiation. The remaining 26 (81%) patients underwent 31 tumor resections with curative intent. Seven (22%) patients had previously undergone a resection or biopsy at another institution. There were 10 second-time resections, 2 third-time resections, 1 fourth-time resection, and no operative mortalities. Median survival was 3 years, with estimated survival at 6 months and 1, 5, and 10 years of 90%, 73%, 31%, and 17%, respectively. Of the 8 (25%) who were considered disease-free following surgery, 4 experienced recurrences during follow-up. Conclusions: Primary cardiac sarcoma continues to be a challenging disease with poor prognosis. Aggressive resection with curative intent, frequent surveillance for local and distant recurrence, and systemic and local multimodality treatment optimizes outcomes.
