Total Artificial Heart Support with Two Continuous-Flow Ventricular Assist Devices in a Patient with an Infiltrating Cardiac Sarcoma

Abstract

Primary cardiac sarcoma is normally fatal, but cardiac replacement may provide some hope for long-term survival. A 38 year-old man with cardiac sarcoma, involving the interventricular septum and posterior wall with intermittent mitral obstruction, underwent implantation of two HeartMate II ventricular assist devices for total artificial heart support. After cardiectomy, the HeartMate sewing rings were sewn to the right neoatrium and the left atrial remnants. After the outflow grafts were sewn end to end to the pulmonary artery and aorta, the two drivelines were externalized through the abdominal wall, and perfusion started. The postoperative course was complicated by respiratory and renal dysfunction, which resolved. After 6 months of support, the patient has normal organ function and is ambulatory. Follow-up oncologic evaluation of positron emission tomography-computed tomography scan is negative.

Extracorporeal total artificial heart as bailout surgery

“…Our research yielded 10 studies, the first published in 2002 by Sezai et al and the last in 2013 by Pirk et al Their characteristics are outlined in Table . They are all case reports and descriptions of surgical techniques, most reporting on one case only, except Latif et al who presented a series of 22 patients.…”

“…Cardiomyopathy was also frequently observed. There is one case of cardiac amyloidosis reported by Frazier and Cohn, one of an intra‐cardiac tumor, and cases were the patient's heart had anatomic defects which where irreparable. Ubilla et al reported a case where the patient had multiple previous surgeries for aortic valve disease and was admitted for heart transplant, but technical considerations and the anticipation of a difficult dissection led the team to choose a two‐step procedure, removing the ventricle and implanting two VADs first before proceeding with the transplantation.…”

“…Various techniques to rebuild the atria and avoid collapse include direct suture to prosthetic grafts, reinforcing of the atrial wall with glue, or bovine pericardium patches . Frazier and Cohn used custom‐made cones of Vascutek Gelseal patches (Terumo Cardiovescular Systems Corporation, Ann Arbor, MI) reinforced with hernia mesh repair and impregnated with silicone adhesive, and sutured them to the remains of the atria.…”

Angiosarcoma Causing Cardiac Constriction Late after Radiation Therapy for Breast Carcinoma

“…9 In patients with an early diagnosis and no metastases, several reports have described improved survival rates and increased disease-free intervals consequent to aggressive surgical and multimodal treatment with chemotherapy and RT. [8][9][10] These patients were alive and symptom-free at their follow-up evaluations 9 months or more after therapy.…”

“…10 The risk of a patient's developing post-RT sarcoma can be reduced by careful selection of cancer patients in accordance with established guidelines on radiosensitive tumors and by choosing targeted therapy, such as intensity-modulated protonbeam RT over conventional RT. Proton-beam therapy, however, is not yet widely available and not yet proven.…”