Early and intermediate outcomes of surgical treatment for atrial myxoma complicated by preoperative ischemic stroke: a retrospective study

BACKGROUND: Patients with left atrial myxoma and concomitant ischemic stroke continue to face a significant risk of recurrent cerebral embolism. However, the safety and feasibility of cardiopulmonary bypass (CPB) surgery within 3 months post-stroke remain unclear. This study aims to investigate the safety and clinical outcomes of early surgical intervention in this high-risk cohort. METHODS: We conducted a retrospective analysis of 364 patients who underwent surgical resection of left atrial myxoma at the Second Xiangya Hospital between 2011 and 2024. Patients were stratified into two cohorts based on the presence or absence of preoperative ischemic stroke: an ischemic stroke group (n = 66) and a non-stroke group (n = 298). Within the ischemic stroke cohort, patients were further divided into three subgroups based on the time interval between stroke onset and cardiac surgery: early (1-30 days), intermediate (31-90 days), and late (> 90 days). Preoperative conditions, comorbidities, stroke timing, brain infarct locations, neurological symptoms, and postoperative neurological recovery were evaluated. The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity. The modified Rankin Scale (mRS) was used to assess neurological recovery. RESULTS: Among the 364 patients, 66 (18.1%) had preoperative ischemic stroke. There were no in-hospital deaths in either the ischemic stroke or non-stroke groups. Postoperative neurological deterioration was not observed in the ischemic stroke group. The NIHSS was used to assess 40 out of 66 patients with ischemic stroke, all of whom had scores ≤ 20. In the early subgroup, 17 out of 25 ischemic stroke patients (68%) achieved full neurological recovery; in the intermediate subgroup, 13 out of 18 patients (72.2%) recovered fully; and in the late subgroup, 16 out of 23 patients (69.6%) achieved full recovery. Long-term survival was not significantly different between the two groups or among the three subgroups. CONCLUSION: Early surgical intervention in patients with left myxoma complicated by preoperative ischemic stroke does not lead to significantly worse postoperative outcomes. Early cardiac surgery may be considered for patients without very severe ischemic stroke.