Treatment Results of LVAD Implantation and Heart Transplantation for Oncotherapy Induced Cardiomyopathy in Women and Men

Abstract

<h3>Purpose</h3> Due to the increase of patient's survival after different types of malignancies, patient's cardiovascular morbidity during these treatments is rising in mid and long term. Heart failure is one of these entities- mainly due to the increasing complexity of chemotherapeutic substances and preexisting heart disease. <h3>Methods</h3> We retrospectively analyzed our patient's files to assess the options and outcome of HF therapies after tumor related therapy. <h3>Results</h3> Out of 450 patients treated at our institution for HF after oncological therapy 46 pts. (14 female/32 male) received advanced surgical heart failure therapy as LVAD implantation and/or and heart transplantation (HTx). The individual types of tumor and the timeline of individual therapies will be reported. Heart transplantation was considered to be possible again 5 years after tumor treatment and recurrence free oncological follow up. Surgical procedures took place during Jan 2011 and May 2021. At the time point of tumor diagnosis, women were 37,9 ± 12 years of age and developed severe heart failure 10,25 ± 4 years later. Men at time point of tumor diagnosis, were 44 ± 16 years. Terminal heart failure was diagnosed and surgically treated 7,2 ± 4 years later in men. This age related disparity is due to different carcinoma entities among men and women. 35 patients received an LVAD exclusively. 3 patients recovered from VAD. 7 patients initially received LVAD followed by subsequent HTx in 4 cases. 3 pts. still are listed for Htx. Four patients underwent primary heart transplantation. Preexisting heart failure was present in 5 % of women and 7 % of men prior to the diagnosed malignancy. 80 % of women and 72 % of men are alive. <h3>Conclusion</h3> Terminal heart failure is one the leading morbidities in oncological patients in mid and long term caused by available treatment options. Higher age and better survival make advanced HF therapies (LVAD/HTx) possible with reasonable results. Patients should be referred early to evaluate these specific options.