Cardiac Autotransplantation for Primary Cardiac Tumors Michael J. Reardon, MD, S. Chris Malaisrie, MD, Jon-Cecil Walkes, MD, Ara A. Vaporciyan, MD, David C. Rice, MD, W. Roy Smythe, MD, Clement A. DeFelice, MD, and Zbigniew J. Wojciechowski, MD Methodist DeBakey Heart Center, The Methodist Hospital; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Department of Thoracic and Cardiovascular Surgery, M.D. Anderson Cancer Center, Houston; and Department of Surgery, Scott & White Hospital, Texas A&M University, Temple, Texas Background. Complete tumor resection is the optimal treatment of cardiac tumors. Anatomic accessibility and proximity to vital structures complicates resection of tumors involving the left heart. The results of standard resection and resection with orthotopic heart transplantation are dismal. We, therefore, reviewed our series of patients with complex left-sided primary cardiac tumors who underwent tumor resection with cardiac autotransplantation. Methods. Since April 1998, 11 consecutive patients with complex left atrial or left ventricular intracavitary cardiac tumors underwent 12 resections using cardiac autotrans- plantation— cardiac explantation, ex vivo tumor resec- tion with cardiac reconstruction, and cardiac reimplanta- tion. Demographics, tumor histology, operative data, and mortality were analyzed. Follow-up was complete in all patients. Results. Complete resection by cardiac autotransplan- tation was used in 7 patients with left atrial sarcoma, 1 patient with left ventricular sarcoma, 2 patients with left atrial paraganglioma, and 1 patient with a complex giant left atrial myxoma. Eight patients had previous resection of their cardiac tumor, and 1 patient had a repeat auto- transplantation for recurrent disease. There were no operative deaths. Median overall survival was 18.5 months in patients with sarcomas. All patients with benign tumors are alive without evidence of recurrence. Conclusions. Cardiac autotransplantation is a feasible technique for resection of complex left-sided cardiac tumors. Recurrent disease after previous resections can be safely treated with this technique. Operative mortality and overall survival seems favorable in this series of patients. Benefits of this technique include improved accessibility and ability to perform a complete tumor resection with reliable cardiac reconstruction. (Ann Thorac Surg 2006;82:645–50) © 2006 by The Society of Thoracic Surgeons P rimary cardiac tumors are uncommon clinical entities with an incidence of 0.0017% to 0.03% [1, 2]. The majority of these tumors are benign atrial myxomas, which can be successfully managed by surgical excision [3]. Malignant cardiac tumors, however, continue to present a difficult therapeutic challenge, especially those tumors involving the left heart. Surgical resection is often necessary to alleviate the severe symptoms associated with these tumors, but is, nevertheless, associated with poor long-term prognosis [4]. Because of the rarity of primary cardiac malignancies, therapeutic concepts and methods of surgical resection have not been standardized. To overcome the technical challenges of complete resection of left-sided tumors with accurate cardiac re- construction, we have used a technique of cardiac ex- plantation, ex vivo tumor resection with cardiac recon- struction, and cardiac reimplantation— cardiac autotransplantation. Including our first successful case published in 1999 [5], we have performed this technique on 11 consecutive patients with presumed left atrial or intracavitary left ventricular primary cardiac malignant tumors. We sought to evaluate the feasibility of this approach for primary resection and resection for recur- rent disease. Patients and Methods Patients From 1998 to the present, 11 patients with complex left-sided cardiac tumors underwent 12 operations using cardiac autotransplantation. Eight patients had malig- nant tumors and 3 had benign tumors (Table 1). All cases were performed by a single surgeon (M.J.R.) at either The Methodist DeBakey Heart Center (10 operations) or the M.D. Anderson Cancer Center (2 operations). Demo- graphics, tumor histology, operative data, and mortality were analyzed. Follow-up was complete in all 11 patients. Individual informed consent was obtained to perform the procedure, and consent for research authorization was obtained at the time of admission from each patient. In addition, formal internal review board approval was obtained for this retrospective study. Accepted for publication Feb 27, 2006. Address correspondence to Dr Reardon, 6560 Fannin St, Suite 1002, Houston, TX 77030; e-mail: mreardon@tmh.tmc.edu. © 2006 by The Society of Thoracic Surgeons 0003-4975/06/$32.00 Published by Elsevier Inc doi:10.1016/j.athoracsur.2006.02.086 CARDIOVASCULAR