Basel Ramlawi1, Odeaa Al-Jabbari1, Lance N Blau1, Mark G Davies1, Brian A Bruckner1, Shanda H Blackmon2, Vinod Ravi3, Robert Benjamin3, Limael Rodriguez1, Oz M Shapira4, Michael J Reardon5. 1. Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas. 2. Houston Methodist Department of Surgery, Division of Thoracic Surgery, Houston Methodist Hospital, Houston, Texas. 3. Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Cardiothoracic Surgery, Haddasah Hebrew University Medical Center, Jerusalem, Israel. 5. Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas. Electronic address: mreardon@houstonmethodist.org.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Brian A Bruckner; Walid K Abu Saleh; Odeaa Al Jabbari; Jack G Copeland; Jerry D Estep; Matthias Loebe; Michael J Reardon Journal: Tex Heart Inst J Date: 2016-06-01
Authors: Walid K Abu Saleh; Odeaa Al Jabbari; Basel Ramlawi; Brian A Bruckner; Matthias Loebe; Michael J Reardon Journal: Tex Heart Inst J Date: 2016-04-01
Authors: Hyun Oh Park; Jun Ho Yang; Sung Hwan Kim; Seong Ho Moon; Joung Hun Byun; Jun Young Choi; Chung Eun Lee; Jung Wook Yang; Jong Woo Kim Journal: J Korean Med Sci Date: 2017-09 Impact factor: 2.153
Authors: Uladzimir U Andrushchuk; Youry P Ostrovsky; Andrei V Valentsiukevich; Liana G Shestakova; Siarhei G Amelchanka; Valery G Krutau; Olga A Yudina; Pavel F Chernoglaz; Irina I Grinchuk; Andrei Smalenski Journal: Kardiochir Torakochirurgia Pol Date: 2017-12-20