Outcomes of Full and Partial Cardiac Autotransplantation for Complex Left-Sided Heart Tumors

Complex or malignant left-sided heart tumors present a challenge for resection and reconstruction. Cardiac autotransplantation was developed to address this but is a complex technique. Partial autotransplantation was developed to simplify the procedure. This study evaluates the outcomes of partial cardiac autotransplantation compared with those of full cardiac autotransplantation.

We analyzed our prospectively collected cardiac tumor database for cases between 1998 and 2022 requiring full or partial cardiac autotransplantation. The primary end points for the study were morbidities including bleeding, total blood transfusions, renal failure, prolonged ventilation (>48 hours), arrhythmias, total cardiopulmonary bypass time, total aortic clamp time, hospital length of stay, and intensive care unit length of stay. The secondary end point was operative 30-day mortality.

We identified 57 consecutive cases of partial or full cardiac autotransplantation. Full autotransplantation was performed in 47 of 57 (82.5%) patients, and partial autotransplantation was performed in 10 of 57 (17.5%) patients. For full vs partial techniques, mean cardiopulmonary bypass time was 191.0 vs 147.5 minutes (P = .01), and median number of blood transfusions was 5.0 vs 2.0 units (P = .04). Mean aortic clamp time was 120.5 vs 103.0 minutes (P = .12), median length of hospital stay was 12.0 vs 8.5 days (P = .23), and intensive care unit stay was 5.0 vs 2.0 days (P = .14); renal failure (9/47 [19%] vs 0) did not differ (P = .34). There was no 30-day mortality in the partial group.

Partial cardiac autotransplantation represents a simplification of the full autotransplantation technique and can be performed with a reasonable operative risk.