Right atrial tumors from myxoma to malignancy: early surgical outcomes in 29 patients at a single center

Abstract

Background: Right atrial tumors are rare, carry a high rate of malignancy and range from benign myxomas to primary or secondary malignant tumors, yet data from Vietnam remain limited. We asked what the early surgical outcomes are and how benign and malignant tumors differ in imaging features and surgical strategy. We aimed to evaluate early outcomes of right atrial tumor surgery and to compare benign with malignant tumors. Methods: This retrospective case series included all 29 patients who underwent resection of a histologically confirmed right atrial tumor at Cho Ray Hospital, Vietnam, between January 2021 and January 2026. Results: Mean age was 50.7 ± 11.6 years and 58.6% of patients were men. Malignant tumors accounted for 41.4% (sarcoma 5, lymphoma 5, invasive thymoma 2), half of them secondary. Compared with benign tumors, malignant tumors were more often sessile (100% versus 11.8%), with moderate-to-large pericardial effusion (58.3% versus 0%) and invasion of the atrial wall (66.7% versus 0%) or superior vena cava (41.7% versus 0%). Eleven of 17 benign tumors were removed through a right minithoracotomy and macroscopically complete resection was achieved in 28 of 29 patients. Eleven of 12 malignant tumors required reconstruction, with longer bypass and operative times. There was no in-hospital death; Clavien–Dindo grade III complications occurred in 37.9% and 17.2% of patients required a permanent pacemaker. Among patients with follow-up, 30-day mortality was 5.6% and 6-month survival was 94.4%. Conclusions: Surgery for right atrial tumors achieved safe early outcomes, including malignant tumors requiring extended resection and reconstruction. Preoperative imaging guides the surgical strategy and conduction system injury is the main specific complication.