Cardiac autotransplantation: benefit over risk

Background: Giant left atrium with recurrent mitral regurgitation poses significant surgical challenges, particularly in reoperative settings. Cardiac autotransplantation offers a unique approach for full access and effective chamber reduction. Case Report: A 54-year-old male with a prior mechanical mitral valve presented with severe paravalvular regurgitation and massive left atrial enlargement. He underwent cardiac autotransplantation with mitral valve repair, left atrial reduction, and a Cox-Maze procedure. The surgery was successful, and postoperative recovery was uneventful. Long-term follow-up showed restored sinus rhythm, reduced atrial size, and improved functional status. Pre- and postoperative chest X-rays demonstrated significant cardiac remodeling. Conclusion: Cardiac autotransplantation is a viable option for complex mitral valve reoperations involving giant left atrium, especially when conventional or transplant options are limited.