Primary cardiac angiosarcoma is an exceptionally rare and aggressive malignant tumor arising predominantly from the right atrium. Its clinical presentation is often nonspecific, contributing to delayed diagnosis and poor prognosis. Although surgical excision remains the mainstay of treatment, it poses substantial challenges due to tumor friability, risk of embolization, and life-threatening hemodynamic instability during cardiopulmonary bypass (CPB). This paper provides a comprehensive overview of the pathophysiology, clinical features, and diagnostic methods of cardiac angiosarcoma, with a special emphasis on the perfusionist’s role in optimizing intraoperative management. The discussion highlights CPB strategies, cannulation techniques, hemodynamic considerations, and risk mitigation approaches essential for safe tumor resection. By evaluating current knowledge and integrating perfusion-specific perspectives, this paper aims to broaden the understanding of how the multidisciplinary cardiac surgery team can improve surgical outcomes in this rare but devastating malignancy