Operative management of cardiac papillary fibroelastomas.

Autor:	Mazur P; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Kurmann R; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Klarich KW; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Dearani JA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Arghami A; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Daly RC; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Greason K; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Schaff HV; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn., Ahmad A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., El-Am E; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Sorour A; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn., Bois MC; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn., Viehman J; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn., King KS; Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn., Maleszewski JJ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn; Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minn., Crestanello JA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: crestanello.juan@mayo.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Mar; Vol. 167 (3), pp. 1088-1097.e2. Date of Electronic Publication: 2022 Jul 16.
DOI:	10.1016/j.jtcvs.2022.06.022
Abstrakt:	Objective: Papillary fibroelastomas are associated with an increased risk of embolic strokes. Excision of papillary fibroelastomas may be the primary indication for surgery (primary) or performed during other cardiac operations (secondary). The present study summarizes our experience with primary and secondary fibroelastoma surgery. Methods: We analyzed the medical records of patients who underwent surgical excision of papillary fibroelastoma between January 1998 and February 2020. Patient characteristics, indications for operation, tumor size and location, and operative and long-term outcomes were evaluated. Results: Among the 294 patients (median age: 66 years, 62% female), papillary fibroelastoma was the primary indication for surgery in 136 patients (46%), and 51% of patients had a history of stroke or transient ischemic attack. When papillary fibroelastoma was a secondary indication for surgery (158 patients, 54%), the lesion was identified preoperatively in 39%. Papillary fibroelastomas were located most commonly on the aortic valve and least commonly in the right side of the heart. For valvular papillary fibroelastoma resected from a normal valve, valve shave was sufficient in 96% (196/205). Operative mortality was low in both groups (primary, 0% vs secondary, 2.5%, P = .13), and early neurologic events occurred in 1.3%. Recurrence rate was 15.8% at 10 years. The estimated survival for patients with primary papillary fibroelastoma at 10 years was 78.4%, whereas for secondary papillary fibroelastoma removal it was 53.6% (log rank, P = .003). Conclusions: Resection of papillary fibroelastomas can be performed safely, with preservation of the native valve, and with low rates of neurologic events. Operative and long-term outcomes after fibroelastoma resection are excellent. (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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