Surgical Management of Cardiac Myxomas in Elderly Patients

Objective: Cardiac myxoma usually presents during early adulthood. There is generally a tendency for prompt surgical resection. However, advanced age of patients presenting with this disease may increase the operative risk due to other cardiac and non-cardiac problems. Therefore, we evaluated elderly patients who underwent surgery for myxoma to review the management of treatment.Methods: Between September 1985 and March 2012, a total of 17 consecutive patients over 65 years of age (5 male, 12 female; mean age: 69.3±3.5 years) who had undergone surgical resection for cardiac myxoma were analyzed retrospectively. Echocardiography had been performed in all patients to diagnose the myxoma and evaluate other cardiac pathologies. Coronary angiography had been performed in all patients except in two cases who underwent emergency surgery.Results: Thirteen patients (76.4%) survived the operation. Two patients who underwent emergency operation died early and four patients died during the follow-up time. Concomitant procedures included coronary artery bypass grafting in two, radiofrequency ablation in one, mitral valve reconstruction in one and femoral embolectomy in one patient.Conclusions: In an era of aging population, myxoma tends to be diagnosed more frequently in elderly and high-risk patients. Complete preoperative assessment of these patients is a more appropriate approach in stable patients than the traditional emergency surgery applied to all cases

Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis The Multicenter HATTUSHA Study

BACKGROUND Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT. (J Am Coll Cardiol 2022;79:977-989) (c) 2022 by the American College of Cardiology Foundation