Surgical management of cardiac pheochromocytoma: Resection versus transplantation

Objective: The authors review their experience and that of others who have reported cases in the literature on the surgical management of cardiac pheochromocytomas. Summary Background Data: Cardiac pheochromocytomas are rare cathecolamine producing tumors that can be densely adherent to myocardium. Because resection can be associated with significant morbidity, we sought to determine the best mode of treatment for these difficult tumors. Method: The authors reviewed the experience for management of cardiac pheochromocytomas in their two institutions and those reported in the literature. Follow-up was available for 21 of 26 patients up to 9 years after resection. Results: Twenty five patients had reconstruction of the native heart; five (20%) died intraoperatively from hemorrhage, one (4%) died postoperatively from sepsis, three (12%) sustained myocardial infarction, one (4%) required a mitral valve replacement, and three (12%) had incomplete resections, two of whom subsequently developed metastatic disease and died. One patient, thought to be a high risk for resection, received an orthotopic heart transplantation. Conclusions: Surgical resection of cardiac pheochromocytomas can be performed successfully. However, resection of lesions that aggressively invade adjacent myocardium is associated with significant mortality and inadequate control of the neoplasm. Cardiac transplantation should be available as an option before embarking on resection, and it should be performed if mandated by intraoperative findings.