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cardiac auto transplantation

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Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD † C ard iactumors are unu sua l and ca rdi ac mal ignanc y, usu- ally sarcoma, is a very small subset of these. The litera- ture on cardiac sarcomas of the left heart often exhibited multiple operations for local recurrence, which we believed was related to inadequate resection, likely exacerbated by poor anatomi c expos ure of the posterior heart for comp lex resection and reco nstruction. Sinc e November 1998, we have approached large complex sarcoma of the left atrium or left ventricle using the technique of cardiac explantation, ex vivo tumor resection, and cardiac reconstruction and re- implanta tion of the hear t— card iac autot ransplantatio n. This allows complete exposure of left heart structures for aggres- sive resection and accurate reconstruction, permitting the removal if necessary of the entire left atrium and good expo- sure for removal of intracavitary left ventricular tumors. This technique has also been applied to large complex benign left atrial tumors such as giant myxoma and paraganglioma. We have had only one local recurrence and no mortality when only cardiac autotransplantation was necessary in 19 pa- tients. When pneumonectomy was required in addition to cardiac autotransplantation, the mortality was 57% (4/7 patients). Pneumonectomy is usually required due to com- plete involvement of the pulmonary veins and should be carefully looked for in the preoperative evaluation and considered a contraindication for surgery except in ex- treme circumstances. 1-12 *Division of Thoracic Surgery, Department of Surgery, The Methodist Hos- pital, Houston, Texas. †Division of Cardiac Surgery, Department of Cardiovascular Surgery, The Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, Texas. Dr. Reardon reports consulting fees from Medtronic.  Addre ss reprint reques ts to Mic hae l J. Rea rdo n, MD,Cardio vas cul ar Surg ery  Associates, The Methodist Hospital, 6550 Fannin Street, Suite 1401, Houston, TX 77030. E-mail: [email protected] 147 1522-2942/$-see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1053/j.optechstcvs.2010.03.002

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