Autotransplantation for the resection of complex left heart tumors

Complete surgical resection is the optimal treatment for malignant and complex benign left heart tumors. Anatomic inaccessibility and relationship with vital cardiac structures, makes complete resection of these complex tumors with standard surgical technique suboptimal. We employ autotransplantation in these cases to allow optimal anatomic exposure for complete resection and accurate reconstruction.

From 1998 to 2013, 35 cardiac autotransplants were done in 34 patients. Demographics, tumor histology, operative notes, hospital data, pathology reports, morbidity, and short and long-term mortality data were analyzed. Mortality follow-up was complete in all patients.

Of the 34 patients, there were 26 primary cardiac sarcomas, 1 isolated malignant melanoma metastasis to the intracavitary left ventricle, and 7 benign cases. The benign group had no operative deaths and 100% 2-year survival. Overall 30-day, 1-year, and 2-year procedural survival was 85%, 59%, and 44%, respectively. For primary malignant tumors, survival at 1 and 2 years was 46% and 28%. Among patients with primary malignant tumors, 19 had isolated cardiac autotransplantation and 7 had autotransplantation plus pneumonectomy. Operative mortality (and median survival) for cardiac autotransplantation with and without pneumonectomy was 43% (55 days) and 11% (378 days), respectively. For primary sarcomas, microscopically positive or negative resection margins did not impact survival.

Cardiac autotransplantation is a feasible and safe technique for resection of complex left-sided tumors when done as an isolated procedure in experienced centers. Addition of concomitant pneumonectomy carries a high rate of mortality and should be avoided. Further studies are needed to validate these results.