Key result
Concomitant pneumonectomy during cardiac autotransplantation increases early mortality by ~32 percentage points.
Why the study?
Robust data on clinical outcomes of cardiac autotransplantation for complex left-sided cardiac tumors remain limited.
Systematic Review (n=56)
Cardiac autotransplantation is a feasible surgical option for complex left-sided cardiac tumors with acceptable risk, though perioperative mortality increases significantly when combined with pneumonectomy.
Supports caution with concomitant pneumonectomy in cardiac autotransplantation; leaves open refined selection criteria for invasive tumors.
INTRODUCTION: Cardiac autotransplantation is a rarely used surgical technique for managing complex left-sided cardiac tumors. Although its use has been reported in select series, robust data on clinical outcomes remain limited. This study aimed to synthesize all available evidence to provide a comprehensive overview of its application and outcomes. METHODS: A systematic search was conducted in June 2025 to identify case reports and series describing cardiac autotransplantation for tumor resection. A total of 22 studies comprising 56 patients were included, and patient-level data were extracted for analysis. RESULTS: The median age was 36 [interquartile range, 26-47] years, and 42% (20/48) were female. Primary cardiac tumors accounted for 98% (55/56) of the cases, with sarcoma being the predominant histologic type (52%, 29/56). Tumors were located in the left atrium in 80.3% (45/56) and in the left ventricle in 10.7% (6/56). Tumor invasion involved the lungs in 27% (12/45) of cases and pulmonary veins in 23% (10/44), and resulted in mitral stenosis in 19% (6/31). Neoadjuvant chemotherapy was administered in 29% (12/41), adjuvant chemotherapy in 54% (27/50), and adjuvant radiotherapy in 8% (4/50) of the patients. In-hospital or 30-day mortality was 11% (6/56) and was significantly higher with pneumonectomy (36.4%, 4/11) compared with autotransplantation alone (4.4%, 2/45; P = 0.002). At a median follow-up of 365 [91-870] days, overall survival was 63% (35/56). CONCLUSIONS: Cardiac autotransplantation is a feasible approach for tumor resection with acceptable surgical risk in carefully selected patients. Concomitant pneumonectomy significantly increases perioperative mortality, reflecting the higher risk of complications inherent to this procedure and the greater extent of disease.
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Rahimov et al. (2026) conducted a systematic review in Complex left-sided cardiac tumors (n=56). Cardiac autotransplantation with concomitant pneumonectomy vs. Cardiac autotransplantation alone was evaluated on In-hospital or 30-day mortality (p=0.002). Concomitant pneumonectomy during cardiac autotransplantation for tumors significantly increased in-hospital or 30-day mortality compared to autotransplantation alone (36.4% vs 4.4%; P=0.002).
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