title: Surgery for massive malignant tumors of the left atrium - one center's experience.
abstract: BACKGROUND
  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.
  
  
  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.
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Uladzimir
authors: U
authors: Andrushchuk
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Youry
authors: Y
authors: Ostrovsky
authors: Department of Thoracic Surgery, Republican Scientific Practical Center of Oncology and Medical Radiology of N.A. Alexandrova, Minsk, Republic of Belarus.
authors: Vladimir
authors: V
authors: Zharkov
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Siarhei
authors: S
authors: Amelchanka
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Valery
authors: V
authors: Krutau
authors: Pathology Department, Health Care Institution, City Clinical Pathology Bureau, Minsk, Republic of Belarus.
authors: Olga
authors: O
authors: Yudina
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Tatsiana
authors: T
authors: Ilyina
authors: Department of Cardiac Surgery, Republican Scientific Practical Center 'Cardiology', Minsk, Republic of Belarus.
authors: Irina
authors: I
authors: Grinchuk
keywords: autotransplantation; cardiac sarcoma; heart transplantation