Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass

Abstract

Background: Only few reports exist on malignant thoracic neoplasms that require cardiopulmonary bypass during resection. We aimed to investigate the early and late clinical outcome of these patients.

Methods: Patients with thoracic malignancies that underwent surgery between 2002 and 2014 were analyzed. All patients had cardiopulomonary bypass support during resection. Clinical and perioperative data was retrospectively reviewed for outcome and overall survival.

Results: Fifteen patients (12 female, mean age of 55 ± 15 years, range 24 to 80 years) were identified. Eleven (8 female) were diagnosed with primary thoracic malignomas and four with metastases. Three patients died early postoperatively. Patients diagnosed with sarcoma had a significantly worse outcome than non-sarcoma patients (83.3 ± 15.2 % after 1 year, 31.3 ± 24.5 % after 5 years vs. 83.3 ± 5.2 % after 1 year, 0 ± 0 % after 5 years, p = 0.005).

Conclusions: Malignancies with extension into cardiac structures or infiltration of great vessels can be resected with cardiopulmonary bypass support and tolerable risk. Carefully selected patients can undergo advanced operative procedures with an acceptable 1-year-survival, but only few patients achieved good long-term outcome.

Fig. 1

Preoperative computed tomography scan of patient 11. Carcinoid infiltrating right lung and Vena cava superior

Fig. 2

Preoperative magnetic resonance scan of patient 3. Paraganglioma of the posterior mediastinum infiltrating left atrium completely

Fig. 3

Intraoperative photograph of patient 3. Left atrium is completely infiltrated by paraganglioma

Fig. 4

Intraoperative photograph of patient 3. Left atrium is resected ex vivo after temporary heart explantation and prepared for re-implantation

Fig. 5

Actuarial overall survival after tumor resection of all patients (n = 15)