Atrial Transplantation for Recurrent Cardiac Sarcoma Serban C. Stoica, AFRCS, a Ian M. Mitchell, MD, FRCS (CTh), b James Foreman, FIBMS, c Charles J. Hunt, PhD, c John Wallwork, FRCS, a and Stephen R. Large, FRCP, FRCS a Cardiac transplantation for sarcomas has met with little success and the surgical treatment remains controversial. We describe the case of a 56-year-old woman who was referred for transplantation after two procedures in which undifferentiated atrial sarcoma was locally excised successfully. The patient underwent atrial homograft transplantation, the first reported to date. Advantages of the procedure include wide atrial resection and no need for immune suppression. J Heart Lung Transplant 2001; 20:1220–1223. Cardiac sarcomas are the second most common tumors of the heart after myxomas. The diagnostic and especially the therapeutic difficulties have been reviewed elsewhere. 1–4 Excision is associated with high rates of recurrence. Cardiac transplantation is traditionally contraindicated in patients with malig- nant disease of the heart or other organs. Some investigators have been attracted by the concept of replacing the heart in patients with malignancy localized to the heart and no detectable systemic dissemination. 3–6 Babatasi et al summarized the world experience of 8 cases of heart transplantation for sarcoma with a median survival of 9 months. 7 This is better than the dismal natural history of untreated disease, and also better than the results of resection alone or as part of a combined modality treatment. The median post-operative survival for resection of left-sided leiomyosarcomas is 6.8 months. 7,8 As with other malignancies of the heart treated by transplantation, the optimal immunosup- pression protocol is unknown. 9 Sub-optimal immu- nosuppression calls for rejection and compromises the allograft, whereas conventional doses increase the risk of accelerated manifestation of any meta- static disease. Adjuvant therapies are not without problems either; for instance, radiotherapy to the mediastinum or any chemotherapeutic regimen with cardiotoxic drugs may increase the injury burden to the cardiac allograft. 10 In this context, we present our experience with a case of recurrent sarcoma of the left atrium treated by atrial homograft transplantation. Locally ad- vanced disease prevented us from obtaining a good result. However, the availability of atrial homograft, the technical feasibility of the operation and the lack of need for post-operative immunosuppression make the procedure an interesting therapeutic op- tion. CASE REPORT In 1996, a 56-year-old previously healthy woman presented to her local hospital with symptoms of slowly progressing dyspnea. Echocardiography demonstrated a dumb-bell tumor growing across the atrial septum and she underwent resection of the lesion and reconstruction of septum with autologous pericardium. A small nodule from the posterior leaflet of the mitral valve was also excised. The histology report surprisingly showed undifferentiated sarcoma in all the components of the specimen. A year later, during regular echo- cardiographic follow-up, she was found to have recurrence of tumor in the left atrium (LA). At a second operation, a broad-based lesion was found to have arisen from the posterolateral aspect of From the a Department of Cardiothoracic Surgery and Transplan- tation, Papworth Hospital, Cambridge, UK; b Department of Cardiothoracic Surgery, Nottingham City Hospital, Notting- ham, UK; and c The East Anglia Tissue Bank, Cambridge, UK. Submitted November 10, 2000; accepted April 2, 2001. Reprint requests: Dr. Stephen R. Large, Papworth Hospital, Papworth Everard Cambridge CB3 8RE, UK. Telephone: +44-01480-830541. Fax: +44-01480-364334. E-mail: stephenrlarge@hotmail.com Copyright © 2001 by the International Society for Heart and Lung Transplantation. 1053-2498/01/$–see front matter PII S1053-2498(01)00306-0 1220