00:00–00:30
The chance of getting a sarcoma is about 0.0001. Most physicians have never seen a cardiac sarcoma, much less operating on one. A lot of these involve such large areas of the heart that the only way to really get them completely out is to remove the heart, take out the tumor, and then rebuild the heart. I'm Dr. Michael Reardon, I’m professor of Cardiothoracic Surgery and Allison Family Distinguished Chair of Cardiovascular Research here at the Houston Methodist DeBakey Heart and Vascular Center. Every tumor is unique.

00:30–01:00
Its extension into different portions of the heart is unique, but there are parts that you just can't take out and still have a functioning heart afterwards. Many times we get to the point of where you have to kind of make an intraoperative decision about, can we get this last little bit out and still have a functioning heart afterwards? and sometimes it's a difficult decision to make. My name is Marvin Douglas Adkins. I am one of the staff cardiothoracic and vascular surgeons here at Houston Methodist Hospital.

01:00–01:30
Associate Professor of surgery through Texas A&M. So in 1983, when I was a resident training our doctor, Denton Cooley, a patient was sent over from Italy. They tried to remove a large left atrial tumor. They decided they couldn't do it. Dr. Cooley comes in. He puts this guy’s heart on bypass and cuts his heart out and puts it in a bucket of ice and says, “Now save that, I’m going to want it back.”

01:30–02:00
Now he hadn’t told us what we're going to do. We thought he was going to do a heart transplant. So the nurse and I looked at him and said, “Well, where's the donor heart coming from?” And he said, “No, I'm going to put that one back in.” And the tumor was a paraganglioma in the back of the left atrium. And he cut it out and he rebuilt the atrium, and he sewed the heart back in. Now unfortunately, that particular case didn't work. But it was clear to me that if we did this right, it would work.

02:00–02:30
So in 1998, there was a 18 year old kid who was a student at A&M that had a huge left atrial tumor, and he was dying. He was dying of heart failure ‘cause it was blocking the blood flow, and it was a sarcoma. And his cardiologist asked me, well, do you think you can fix this? I said, well, I think I can, but we're going to take his heart out so I can get back to it, take everything out, rebuild it, and put the heart back in.

02:30–03:00
And he actually did quite well. Left the hospital the first time it was ever done on the planet for a malignant tumor like this. He ended up dying of metastatic disease, but at least we showed this could work. And that's what launched our heart tumor program. Because we data based all our patients. We wrote about our patients, we talked about our patients. And over the years, more and more patients have come into our heart tumor team.

03:00–03:30
Dr. Reardon started the program here about 30 years ago, performing some of the first resections of cardiac tumors in the world, and has grown the largest cardiac tumor program in the world. And he's the leading world expert on cardiac sarcomas, as well as resection of all the other tumors that we see that involve the heart. Building heart tumor program has been a big part of my career, something I've been deeply invested in.

03:30–04:00
But I've turned 70 now, and I realize I'm not going to do this forever. And I want this to be our heart tumor program, not Mike Reardon’s practice of heart tumors. Marvin Akins, whose one of the best surgeons I've ever worked with, is now doing these. I operate with him, but he operates as the surgeon. He's probably done 40 of these now. I hope he does 100 before I completely retire.

04:00–04:30
But what I want the world to know is that when I step away, the program remains absolutely the same with somebody who is widely experienced. And we can still offer the best care for cardiac tumors, any place in the planet. These patients, their best long term survival is if you can get what's called an R0 resection. And so many times during these operations, we look at the imaging beforehand, whether that CT or MRI.

04:30–05:00
And we have kind of a general game plan going in. But many times, intra operatively, we have to kind of decide how far can we go to get that negative resection margin and then reconstruction wise, afterwards, sometimes we have to replace valves. Sometimes we have to do bypasses to the coronary arteries. If they're involved. And then, many times we have to reconstruct the left atrium or the pulmonary veins. Typically with bovine pericardium off the shelf.

05:00–05:30
The survival rates, at least for primary cardiac sarcoma, are not very good. So the one year survivals, maybe 40%, the five year survivals, maybe 10%. Using an approach of neoadjuvant chemotherapy beforehand, an aggressive surgical approach of resection, trying to get a negative margins and sometimes even having to resect lungs if it's going into the pulmonary veins. We've doubled the survival rate to around 88%, in our one year series, five year survival, somewhere around 40%.

05:30–06:00
So it's still a very tough tumor. There's still many challenges and many opportunities for improvement down the road. And it really does take a multidisciplinary approach, to maximize patient benefit. Most places do not have folks that are comfortable dealing with these. And so, Dr. Reardon, over the last 30 years has really created the center of excellence in the United States for cardiac tumors. And I'm just really proud to be a part of that.