Ventricular assist device support for children with chemotherapy-induced cardiomyopathy and advanced heart failure: Perspectives gained from a single-center experience.

Abstract

Guidance and data on ventricular assist device (VAD) support for children with chemotherapy-induced cardiomyopathy, particularly within the first 2years after chemotherapy, are limited. We performed a single-center retrospective case series, reviewing medical records of children <18years of age with chemotherapy-induced cardiomyopathy and advanced heart failure (HF) who received durable VAD support. Six patients met inclusion criteria-5 HeartWare™ HVAD, 1 Berlin Heart EXCOR® . Median age at cancer diagnosis was 6years (IQR 4.5-10years). Median dose of anthracycline received was 540mg/m2 (IQR 450-630mg/m2 ). All patients developed HF within 1year after initiation of cancer treatment (median 8months, IQR 6-11.5months) and were initiated on durable VAD support at a median of 8months after completion of cancer treatment (IQR 3.3-43.5months). Four patients had significant right ventricular dysfunction needing oral pulmonary vasodilator therapy, one patient had a major bleeding complication, and two patients had thromboembolic strokes while on VAD support. Median duration of VAD support was 7.5months (IQR 3-11.3months). Two patients underwent VAD explant due to recovery of LV function, one died due to cancer progression, and three underwent heart transplantation. Durable VAD support should be considered as a therapeutic option for children who have advanced HF due to chemotherapy-induced cardiomyopathy, even within 2years of completing cancer treatment. A multi-disciplinary approach is essential for appropriate patient selection prior to implant and to ensure comprehensive care throughout the duration of VAD support.