Heart transplantation in the treatment of primary non-operable cardiac tumors

Tumor resection within healthy tissues is the main treatment method for patients with primary benign cardiac tumors, which account for up to 90% of all primary cardiac tumors [1–3]. Short-term and long-term results after such interventions are generally good, and the 10-year recurrence-free survival is about 93–100% [3, 4]. Even in the case of incomplete resection of a benign cardiac tumor because of its size and localization (mostly in large intramural ventricle tumors), the prognosis is still good, because these tumors grow slowly and are not associated with a systemic adverse influence [5]. Patients with non-resectable benign cardiac tumors may be candidates for orthotopic heart transplantation (OHT) [6, 7].
Primary malignant tumors, of which 75% are sarcomas [8], are commonly diagnosed at an advanced stage, because of rapid growth; and only in 15% of patients is it possible to perform tumor resection, and this without significant prognosis improvement [8]. In the natural disease course average survival time in this category of patients is about 10 months after diagnosis [8, 9]. Polychemotherapy (PCT) and radiotherapy (RT) do not provide improvement of long-term survival [10]. Extended resections of tumor-involved cardiac structures and reconstructive interventions with heart autotransplantation (HA) in combination with neo-adjuvant and adjuvant PCT and RT in selective cases may improve long-term survival in patients with primary malignant tumors of atria, and to a lesser extent in patients with involvement of ventricles [11]. Local tumor recurrence even after pathology-proven radical resection (R0) is the main cause of mortality in the early and midterm postoperative follow-up period [2, 3, 6]. Until now OHT has rarely been performed in patients with primary non-resectable malignant cardiac tumors because of controversial results achieved [6, 12, 13], because of donor-heart deficit and because of the legislation in several countries against performing such interventions to treat this pathology [3]. However, there is still a certain interest in this intervention as a method of treatment for primary malignant cardiac tumors, because of separate successive examples [14] and the absence of effective alternative treatment. In this report we present our experience in performing OHT for primary benign and malignant cardiac tumors.
Two patients (1 male and 1 female) with non-resectable cardiac tumors were surgically treated at SI RSPC Cardiology...


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