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).