Surgical Treatment of Cardiac and Pulmonary Sarcomas

Primary cardiac tumors have an autopsy incidence of between 0.02% and 0.04% or about 200 tumors per 1 million autopsies. Approximately 75% of these neoplasms are benign and 25 % malignant. Primary cardiac sarcomas (PCS) make up over 75% of the primary malignant tumors. The rarity of primary cardiac tumors has led to a minority of surgeons and even few institutions having substantial experience with their treatment. Surgical resection of primary cardiac sarcoma is the mainstay of therapy but is less well understood and far more difficult. Additionally, the preoperative evaluation, preparation and decision making about the ability to achieve complete resection can be complex and has not been standardized. We separate sarcoma into right heart, left heart and pulmonary artery sarcoma as anatomic location often dictates the clinical presentation and the surgical options available. This manuscript presents our approach to the evaluation, preparation and surgical techniques required for treating these primary cardiac sarcomas.