Early and Intermediate Results of Surgery for Atrial Myxoma Complicated by Preoperative Ischemic Stroke: A Retrospective Study

Background Patients with left atrial myxoma complicated by ischemic stroke remain at a significant risk of recurrent cerebral embolism. However, the safety and feasibility of cardiopulmonary bypass surgery within three 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 left atrial myxoma resection at the Second Xiangya Hospital between 2011 and 2024. We evaluated preoperative conditions, comorbidities, stroke timing, brain infarction locations, neurological symptoms, and postoperative neurological recovery. 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. No in-hospital deaths occurred in either the ischemic stroke or no stroke groups. No cases of neurological deterioration were observed in the ischemic stroke group postoperatively. 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 did not differ significantly between the two groups or the three subgroups. Conclusions Early surgery might be beneficial for patients with mild to severe stroke when the NIHSS scores is ≤ 20.