Chapter 22 - Heart Transplantation and Left Ventricular Assist Devices in Cancer Survivors

Abstract

Approximately 5% of patients with advanced heart failure are cancer survivors. About half of these patients have cardiomyopathy as a result of their cancer therapy in the form of chemotherapy-induced or radiation-induced cardiomyopathy. The other half were previously treated for malignancy and have an unrelated cardiomyopathy. For patients at high risk of cancer relapse, left ventricular assist device implantation as destination therapy is the preferred strategy. However, patients at low risk of cancer relapse are candidates for heart transplantation. Patients undergoing heart transplant with a history of cancer are at a higher risk of cancer posttransplant, but survival in these patients is not significantly different than those without a history of cancer. In these patients, certain immunosuppressive strategies, including avoidance of induction immunosuppression and utilization of mammalian target of rapamycin inhibitors may be beneficial.