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

JTCVS Open (Dec 2021)

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.

Journal volume & issue: Vol. 8
pp. 384 – 390

Abstract

Read online

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.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

About the journal

Abstract

Keywords