Embolic complications of cardiac myxoma: A systematic review and meta-analysis of frequency, clinical characteristics, anatomical distribution and outcomes in contemporary cohorts
Arun Dahil, Callum Hill, Cameron Pinn, Piotr Wasilewski, David Hardisty, Matthew Turner, Michaela Scheuermann-Freestone, Simran Dhadda, Arian Arjomandirad, Thanos AthanasiouAbstract
Objectives
Cardiac myxomas are the most common benign primary cardiac tumours and embolise, causing stroke, acute coronary syndrome, limb ischaemia, and visceral infarction. Although previous reviews examined clinical features and embolic risk factors, the frequency, anatomical distribution, management, and outcomes of myxoma-related embolisation have not been comprehensively synthesised.
Methods
We searched MEDLINE, Embase, Scopus, CINAHL, the Cochrane Library, and PubMed from inception to February 2026 for observational studies reporting embolic complications of confirmed cardiac myxoma; small (≤10-patient) and pre-2000 case series were excluded. Random-effects meta-analyses of proportions estimated patient-level embolic prevalence and event-level anatomical distribution.
Results
Across 47 studies (4,964 patients), pooled embolic prevalence was 19.7% (95% CI 16.7–23.1; I²=75.4%, 95% CI 62.8-87.5). Cerebral events predominated (75.6%), followed by peripheral limb (17.0%). Pooled early mortality was 1.9% (95% CI 1.3–2.7). Villous morphology and high tumour mobility were more associated with embolisation than size. Recurrence was uncommon (crude rate 2.0%) and mainly in familial disease or Carney complex.
Conclusion
Embolism is common and predominantly cerebral. Villous surface and tumour mobility were more consistently associated with embolisation than size and may inform the urgency of resection. However, evidence is retrospective; the optimal timing after embolic presentation remains undefined, and prospective validation is required.