Cardiac Autotransplantation for Cardiac Tumors: A Systematic Review.

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.