Adult: Cardiac TumorManagement of primary cardiac paraganglioma
Section snippets
Materials and Methods
Analysis of our cardiac tumor database identified 21 cases of PCP, with 19 undergoing attempted complete surgical resection between March 2004 and June 2020 and 3 refusing the offered surgery. All consecutive patients referred for evaluation were considered for the study, and no patients were excluded except those who refused surgery and consent into the study. Treatment planning was done with a multidisciplinary cardiac tumor board at Houston Methodist Hospital and MD Anderson Cancer Center,
Results
A total of 19 patients underwent attempted complete surgical resection of a cardiac paraganglioma. Baseline patient demographics are presented in Table 1. Individual patient presentations are listed in Table E1, with shortness of breath as the most common symptom. Unlike patients with pheochromocytoma, only 1 patient with cardiac paraganglioma presented with hypertensive or hyperadrenergic episodes. Median age at the time of surgery was 53.4 years (IQR, 35.8-62.8). Eleven patients (57.9%) were
Discussion
The primary finding of this study shows that operative and 30-day hospital mortality are 10.6% in this series. Operative morbidity was substantial in these complex cases, including transfusion in 14 of 19 cases (73.7%) with a median of 5 units of packed red blood cells transfused, cardiac tamponade, mechanical cardiac support including IABP and RVAD, and prolonged respiratory failure requiring tracheostomy. Survival from surgery at 1, 5, and 10 years was 88.2%, 71.8%, and 71.8%, respectively,
Conclusions
Cardiac paragangliomas are rare and surgically challenging tumors because of their vascularity and proximity to critical surrounding structures. Complete surgical excision is the treatment of choice and may benefit from management at experienced centers. Operative mortality is reasonable for this complex disease, and long-term outcomes are favorable in patients with resection having negative or only microscopically positive margins. A multidisciplinary heart tumor team is helpful in our
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Approved by the Houston Methodist Hospital Institutional Review Board.