Reply: “Ex Situ Resection of Primary Cardiac Tumors”

Following our paper on ex situ resection of primary cardiac tumors [[1]], a letter by Kallenbach et al. [[2]] argued against the advantages of autotransplantation. They recommended transsecting only the inferior vena cava and the left atrium with the heart fibrillating, especially with benign tumors. One may agree that an acceptable exposure of the posterior structures of the heart can be obtained with this technique. However, our recent patient presented with a (second) malignant tumor circumferentially neighboring the ascending aorta and the pulmonary trunk, encircling both coronary vessels, and reaching down to the left atrial roof. A tumor like that cannot be resected with the partial ex situ technique reported as has also been stated by Kallenbach et al. Surgery during cardioplegic arrest provides a much better visual field for resection, especially for malign tumors with hard to identify borders compared to surgery with the heart fibrillating. Formerly, we also performed cardiac tumor resections with various partial in situ techniques, but changed our surgical strategy, prefering a totally arrested heart in order to be able to intensively examine the tumor area and achieve the optimal resection. Therefore, we would like to recommend carrying out tumor surgery on the heart only during cardioplegic arrest. The extent of the approach depends on the tumor growth and the necessary exposure respectively.

References

• 1 Hoffmeier A, Scheid H H, Tjan T DT. et al . Ex situ resection of primary cardiac tumors.  Thorac Cardiovasc Surg. 2003;  51 99-101
• 2 Kallenbach K, Haverich A. Explanation of the heart for resection of primary cardiac tumors can be avoided by partial ex situ heart surgery.  Thorac Cardiovasc Surg. 2003;  51 293-294