Ventricular assist devices in patients with chemotherapy-induced cardiomyopathy: new modalities

Abstract

Introduction Cardiotoxicity is a fatal complication of chemotherapeutic agents in which the implantation of a mechanical circulatory support system (MCS) can be a life-saving modality. The aim of this article is to analyse this available therapeutic option for patients with cardiotoxicity induced by treatment of malignancy in the light of current literature. We analysed our recent experience with MCS implantations in patients who have advanced heart failure associated with chemotherapy-induced cardiotoxicity.Methods In the hospital registries of 386 adult cardiomyopathy patients who were supported with a long-term implantable MCS in our institution between January 2008 and June 2012, were retrospectively evaluated. In 11 of these patients (mean age ± SD years; overall %; female/male (n); 42 ± 14, 2.8%, 4/7) MCS was implemented due to chemotherapeutic drug-induced cardiomyopathy (CDIC). Pre-operative and post-operative data of CDIC patients were analysed.Results In this cohort of CDIC patients, mean duration of circulatory support was 413 ± 445 days. One of the patients was successfully bridged to heart transplantation (HTx) after exclusion of possible contraindications. In one patient, left ventricular assist device (LVAD) was successfully explanted after myocardial recovery. In the late post-operative period, fi ve patients expired due to multi-organ failure and gastrointestinal haemorrhage. The remaining 4 patients are still under follow-up on LVAD-support. One of these patients was listed for high-urgency HTx because of device-related infection.Conclusions Cardiotoxicity leading to advanced heart failure is a serious complication of chemotherapeutic agents with a high risk of mortality. In our series LVAD therapy seems to be a benefi cial and safe option. LVAD therapy is an acceptable option in chemotherapy-induced, advanced cardiomyopathy.