Key result
Surgical intervention for massive primary malignant tumors of the left atrium was associated with an 80% rate of major in-hospital complications and a 60% in-hospital mortality rate.
Case Report (n=5)
No
Surgery for massive primary malignant tumors of the left atrium is associated with high morbidity and mortality, though heart autotransplantation with radical resection is considered the treatment of choice by the authors.
Heart autotransplantation may be feasible for select non-resectable left atrial tumors; leaves open its role and outcomes pending larger studies.
INTRODUCTION: Surgery for primary non-resectable malignant tumors of the left atrium is controversial. Today heart autotransplantation as a method of surgical treatment for patients suffering primary massive malignant tumors of the left atrium is still not sufficiently studied. MATERIAL AND METHODS: We provide information on our single-center 5-year experience in performing surgical interventions for massive malignant tumors of the left atrium and including cases of 5 patients (3 males - 60%, 2 females - 40%). One case (1/5, 20%) involved debulking surgery with partial resection of the left atrial (LA) wall and its reconstruction using a xenopericardium patch. Orthotopic heart transplantation was performed in 1 patient (1/5, 20%) and heart autotransplantation (HA) in the 3 other cases (3/5, 60%). RESULTS: Mean myocardial ischemia duration was 165.6 ±12.0 minutes (range: 137-198), cardiopulmonary bypass (CPB) duration was 248.6 ±36.6 minutes (range: 188-392), and intervention duration was 498.0 ±77.4 minutes (range: 330-780). Mean total blood loss was estimated to be 2432 ±616.5 ml (range: 1610-4880). Major in-hospital complications were registered in 4 patients (4/5, 80%). In-hospital mortality was registered in 3 patients (3/5, 60%). Survival time in 2 (2/5, 40%) patients discharged from the hospital was 29 and 9 months, respectively. Both died because of disease progression. CONCLUSIONS: Surgery in patients with massive resectable primary malignant tumor of the left atrium is associated with high incidence of major hospital complications and mortality. Heart autotransplantation with radical tumor resection is the treatment of choice for these cases. The surgical approach implies thorough primary hemostasis and selection of a proper surgical approach, allowing revision of all the regions of intervention during each step. The possibility of excessive tension and bleeding in the area of bicaval anastomosis should be considered when performing heart autotransplantation, and appropriate preventive measures should be applied.
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Andrushchuk et al. (2016) conducted a case report in Primary massive malignant tumors of the left atrium (n=5). Surgical intervention (including heart autotransplantation) was evaluated on In-hospital mortality. Surgical intervention for massive primary malignant tumors of the left atrium was associated with an 80% rate of major in-hospital complications and a 60% in-hospital mortality rate.
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