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Autotransplantation: A New Way to Look at Surgery
Various surgery procedures are used today to treat tumors and/or abnormal valves. The
two most typical operations are, cardiac transplantation, and open heart surgery where the heart
is operated on while it is still left inside the body. If a patient with a damaged heart were given
these two options, both the patient and the patient’s doctor would have many things to consider
before coming to a decision. With cardiac transplantation, there would be the issue of not being
able to find the right donor in time. There are not many available donors, and if there are, there is
the possibility that the patient’s body will reject the donated heart. With the other method, if the
tumor and/or abnormal valve are located in an area difficult to see and reach, it is risky to
operate. Therefore, another procedure, one less risky and with fewer problems, should be
considered. This third method is called cardiac autotransplantation. Cardiac autotransplantation
is the surgical process of reimplanting one’s own cardiac tissue after removing and operating on
it. This could potentially be the best option to the patient. (Conklin & Reardon, 2002).
At the time period of the 1940s through the 1950s, cardiac autotransplantation was first
introduced and attempted for cardiac chest pain, or Prinzmetal angina. At the time it was
introduced, it was concluded as not beneficial because of high morbidity and mortality rates.
Thus the use and experimenting with this procedure was abandoned. In 1985, Dr. Cooley
reintroduced the method to remove a tumor on the left atrium. The operation was accomplished,
but the patient died afterwards. More research, knowledge, and experience from the first two
attempts led to a third attempt, which turned out to be the first successful cardiac
autotransplantation done. Dr. Reardon and his colleagues performed this technique on a 20 year
old patient who had big, persistent, malignant tumors of the left atrium (Conklin & Reardon,
2002). This way of surgery would have many benefits over cardiac transplantation and the
standard open heart surgery. First, autotransplantation does not require a donor’s organ. The long
wait for one is no longer necessary with this surgical procedure. In addition, because
autotransplantation takes one’s own heart to operate, there is no worry over rejection of the heart
by the body. Second, it allows better view of tumors/valves, making them less risky to perform
surgery on. Also, the heart can be turned and rotated to view all areas, but if it is attached to the
body, the view is limited. Excellent exposure of the heart makes it easier and safer to operate on
whatever complication. For the same reasons mentioned in the previous sentence, this technique
is even beneficial when reconstructing the heart back to its original state. Once cardiac
autotransplantation showed to be a considerable method in cutting out tumors, repairing valves,
and reducing the swelling of the atria or other parts of the heart, it became a method further
explored and performed.
Following the first successful autotransplantation, many attempts of the operation have
been recorded in case reports and articles. One article reports on nine patients with giant left
atrium. Although four patients did end up dying postoperatively, all showed significant
differences in their LA diameter. “Mean LA diameter decreased from the preoperative value of
8.6 ± cm to 4.7 ± 0.8 cm” (Erdogan, et al., 2004). Using cardiac autotransplantation as a means
to treat giant left atrium is also recorded in a case report. A 50-year old female patient with GLA
along with mitral valve disease and other complications had “tissues of LA… were incised [cut
open], and right atrium reduction was done” (Barbukhatti, et al., 2009). Within 30 days after the
surgery, she was discharged with great improvement in her health. Several case reports and
articles regarding primary cardiac tumors also show support to the use of cardiac
autotransplantation. For either malignant or benign tumors of the heart, they are usually located
in areas difficult and/or risky to see, yet alone remove and reconstruct. However, with this
procedure, the tumors were exposed, allowing it to be easy to completely remove them. This thus
ensured that the reoccurring of the tumor was unlikely. Compared to the other standard methods
of removing tumors, this technique seems to be more efficient (Conklin & Reardon, 2002;
Reardon, et al., 2006; Reardon, Walkes, DeFelice, & Wojciechowski, 2006; Troise, et al., 2004;
Gammie, Abrishamchian¸ & Griffith, 2007). All or at least most of these cases showed no deaths
during the surgery, but few afterwards. Overall though, most normal functions of the heart were
restored and this method appeared to be effective, reducing risks and creating a safer surgery.
Although there are the many benefits of cardiac auotransplantation compared to typical
procedures, there are still disadvantages to it as well. The issue of cardiac autotransplantation is
that the survival rate is not significantly different from transplantation and standard open heart
surgery. The disadvantage within this technique: “the poor survival associated with these tumors
continues to be… despite improved local control” (Reardon, et al., 2006). Procedures that would
lengthen survival should definitely be researched as it is essential for our world. More and more
people have various heart diseases that need to be treated quickly and efficiently.
Autotransplantation could be potentially the best method, as long as more experience, research,
and technological advances are brought in. It is more beneficial in certain situations than
transplantation and open heart surgery with the heart remained in the body. It is a technique that
should definitely be considered for treatment of certain cardiac complications. However,
currently, not many people are familiar with this technique, nor do they realize its importance.
Which is why, cardiac autotransplantation should be given attention to, as it affects the millions
of people in danger of losing their lives due to the malfunctioning of their hearts.
References
Giovanni, T., Marco, C., Federico, B., Giordano, T., Andrea, A., Zen, M., … Eugenio, Q. (2004). Mid-term
results of cardiac autotransplantation as method to treat permanent atrial fibrillation and mitral
disease. European Journal of Cardio-thoracic Surgery, 25, 1025-1031.
Hasan, B.E., Kaan, K., Suat, N.O., Deniz, G., Omer, I., & Cevat, Y. (2004). Partial Cardiac
Autotransplantation for Reduction of the left Atrium. Asian Cardiovascular and Thoracic Annals,
12, 111-114.
James, S.G., Reza, A., & Bartley, P.G. (2007). Cardiac Autotransplantation and Radical Bi-Atrial Resection
for Recurrent Atrial Myxoma. The Society of Thoracic Surgeons, 83, 1545-1547.
Kirill, O.B., Sergey, Y.B., George, N.A., & Vladimir, A.P. (2009). First experience of cardiac
autotransplantation for giant left atrium treatment. Interactive Cardiovascular and Thoracic
Surgery, 8, 173-175.
Lori, D.C., & Michael, J.R. (2002). Autotransplantation of the Heart for Primary Cardiac Malignancy:
Development and Surgical Technique. Texas Heart Institute, 29, 105-108.
Michael, J.R., Chris, M., Jon-Cecil, W., Ara, A.V., David, C.R., Roy, S., … Zbigniew, J.W. (2006). Cardiac
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Michael, J.R., Jon-Cecil, M.W., Clement, A.D., & Zbigniew, W. (2006). Cardiac Autotransplantation for
Surgical Resection of a Primary Malignant Left Ventricular Tumor. Texas Heart Institute, 33, 495497.