Treatment of cardiac tumors by orthotopic cardiac transplantation

Primary soft tissue tumors of the heart usually cannot be excised with adequate margins. Orthotopic heart transplantation (OHT) could allow complete resection of cardiac tumors and has been performed in selected patients. However, most are not transplanted because of the high risk of tumor recurrence or metastasis and the possible enhancement of tumor growth by immunosuppressive drugs. Six patients with soft tissue cardiac tumors have been transplanted at the Columbia Presbyterian Medical Center: one paraganglionoma and one fibroma (both benign), and four malignant primary sarcomas. In all cases, there was no preoperative evidence of metastasis. In all but one case, the tumor was completely resected with adequate margins at the time of transplantation. One sarcoma patient who had not received preoperative or postoperative chemotherapy died suddenly 2.6 months after operation with no evidence of tumor. One patient is alive at 38 months with diffuse metastatic disease; two patients were treated preoperatively with intensive doxorubicin-based chemotherapy (one of whom also received postoperative external-beam radiotherapy to a positive surgical margin) and are tumor free 16 and 6 months after transplantation. Our experience compares favorably with the worldwide results of OHT for cardiac tumors (an additional 13 patients).