Surgical Resection of Primary Cardiac Tumors: A Systematic Review of Outcomes by Histologic Subtype

Objective. Primary cardiac tumors are rare and the published surgical literature has not been synthesized under the 2021 World Health Organization histotype classification. This review characterizes that literature across the full histotype spectrum using patient-level rather than publication-level denominators. Methods. A systematic search of PubMed, Embase, Scopus, and the Cochrane Library through June 2026 identified studies reporting surgical resection of primary cardiac tumors at any age, classified under that 2021 scheme. The database was audited against source publications; duplicate cohort publications were removed and denominators corrected. Risk of bias was assessed with the Joanna Briggs Institute checklists and the Newcastle Ottawa Scale. Perioperative mortality was pooled at the patient level and stratified. PROSPERO CRD420261415092. Results. Of 765 reports assessed, 38 were excluded, leaving 727 records reporting 10,655 patients (1972–2026). Case reports were 540 records but 581 patients; retrospective cohorts 78 records and 7,409 patients. Median age was 50 years; 60.5% were female. Pooled perioperative mortality was 251 of 8,649 patients (2.90%; 95% confidence interval 2.57–3.28): 2.27% in cohorts against 5.91% in case reports; 2.26% benign and 11.39% malignant (risk ratio 5.03); 2.17% adult and 6.55% pediatric. Right atrial malignant predominance at the publication level (45.9% of records) was absent at the patient level (8.6% of patients in the same records). Conclusions. Resection is reported with a pooled perioperative mortality near 2.9%, five-fold higher for malignant tumors. Publication-level and patient-level analyses of the same literature give opposite answers about tumor location, which should not guide preoperative risk assessment. PROSPERO CRD420261415092.