A difficult decision: what should we do when malignant tumours are diagnosed in patients supported by left ventricular assist devices?

Smail, Hassiba; Pfister, Christian; Baste, Jean-Marc; Nafeh-Bizet, Catherine; Barbay, Virginie; Bessou, Jean–Paul; Peillon, Christophe; Litzler, Pierre‐Yves

doi:10.1093/ejcts/ezv203

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…By contrast, current malignancy, other than localized non‐melanoma skin cancer, is an absolute exclusion from cardiac transplantation . Cases have been described of patients who were implanted with a LVAD in spite of being diagnosed with cancer during the pre‐implantation screening, underwent tumour resection after haemodynamic improvement due to the mechanical support, and finally were transplanted . This scenario is rare, but highlights the challenge for the timing of cardiac and oncological therapies when cancer is discovered in a patient with pre‐existing advanced HFrEF.…”

Section: Challenges In Heart Failure Treatment After a Diagnosis Of Cmentioning

confidence: 99%

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

Ameri

Canepa

Anker

et al. 2018

European J of Heart Fail

159

137

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Cancer and heart failure (HF) are common medical conditions with a steadily rising prevalence in industrialized countries, particularly in the elderly, and they both potentially carry a poor prognosis. A new diagnosis of malignancy in subjects with pre-existing HF is not infrequent, and challenges HF specialists as well as oncologists with complex questions relating to both HF and cancer management. An increased incidence of cancer in patients with established HF has also been suggested. This review paper summarizes the epidemiology and the prognostic implications of cancer occurrence in HF, the impact of pre-existing HF on cancer treatment decisions and the impact of cancer on HF therapeutic options, while providing some practical suggestions regarding patient care and highlighting gaps in knowledge.

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Section: Challenges In Heart Failure Treatment After a Diagnosis Of Cmentioning

confidence: 99%

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

Ameri

Canepa

Anker

et al. 2018

European J of Heart Fail

159

137

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“…Previous case series have reported the outcomes of older LVAD recipients who subsequently developed malignancies; however, none of these patients required anthracyclines. 12,13 In contrast, our patient was young and asymptomatic from a hematologic standpoint. She was interested in treatment options with the best chance of maintaining her quality of life, and we felt that modified HyperCVAD-ponatinib offered the best upfront chance of an early remission even if subsequent doses of chemotherapy could not be given.…”

Section: Discussionmentioning

confidence: 59%

Anthracyclines in a patient with acute leukemia and severe cardiomyopathy requiring mechanical support: A case report

Banerjee

Klein

et al. 2021

J Oncol Pharm Pract

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Introduction For young adult patients with acute leukemia, both the efficacy and cardiotoxicity of anthracycline-based regimens have been documented. We report the case of a patient with severe cardiomyopathy, mechanically supported by a left ventricular assist device (LVAD), who subsequently developed Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph + ALL). To our knowledge, this is the first report of anthracycline administration in a patient with heart failure requiring mechanical support. Case report Our 27-year-old female patient was diagnosed with Ph + B-ALL as part of workup for leukocytosis. Past medical history included non-ischemic cardiomyopathy with a left ventricular ejection fraction of 30–35% and moderate-severe right ventricular dysfunction, for which LVAD had been placed 4 years previously. Management & outcome After shared decision-making and multidisciplinary discussions, we felt that hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone alternating with cytarabine and high-dose methotrexate in addition to ponatinib (HyperCVAD-ponatinib) best balanced the patient's goals for aggressive treatment with the potential for rapid and durable remissions. The patient received a single reduced dose of doxorubicin alongside dexrazoxane with her first cycle of HyperCVAD-ponatinib. She attained a complete molecular response 22 days later and remains in remission (with stable cardiac function) 30 months later on maintenance therapy. Discussion In conclusion, LVAD placement is not an absolute contra-indication to anthracyclines if such therapies offer the best opportunity for a durable response.

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Section: Discussionmentioning

confidence: 99%

“…The presence of a dMCS devise does not preclude patients from undergoing effective surgical or radiation treatments. 28,29 Additionally, dMCS devices offer cardiac support to improve renal and hepatic function. 17,30,31 We chose to include those patients with durable biventricular MCS, TAH, and Thoratec biventricular assist devices in our analysis because although these devices are BTT devices from a regulatory standpoint because in clinical practice, they were employed as a BTC strategy and we felt that an analysis of the implications of clinical decision-making in an unselected cohort of dMCS patients would offer the greatest insight into the relative success of various BTC strategies.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

Zaliznyak

Stern²,

Cole³

et al. 2021

ASAIO Journal

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Durable mechanical circulatory support (dMCS) devices can be offered as a bridge-to-transplant (BTT) or as a bridge-to-candidacy (BTC) strategy for candidates with contraindications to transplant listing, including pulmonary hypertension (BTC-PH), morbid obesity (BTC-Obes), social issues (BTC-Soc), or chronic illness (BTC-Illness). An understanding of the trajectory of BTC patients could guide future triage of advanced heart failure patients who are not candidates for transplantation. We performed a retrospective review all patients who underwent dMCS implantation as either BTT (206 patients) or BTC (114 patients) at our center from January 1, 2010, to March 31, 2020. There was no significant difference in mortality between BTC patients and BTT patients. Compared with the BTT group, significantly more patients in the BTC-PH group were transplanted (81% vs. 63%; p < 0.05) and significantly fewer patients in the BTC-Obes group (44%; p < 0.05) and BTC-Soc group (39%; p < 0.05) were transplanted. Additionally, the readmission rate was higher for those in the BTC-Obes (6.2 vs. 2.1; p < 0.05) and BTC-Soc (3.9 vs. 2.1; p < 0.05) groups. Bridge-to-candidacy patients generally had poorer post-dMCS trajectories than BTT patients. Centers should not be dissuaded from pursuing a BTC strategy for qualified patients; however, careful consideration of potential adverse outcomes is necessary.

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A difficult decision: what should we do when malignant tumours are diagnosed in patients supported by left ventricular assist devices?

Abstract: Malignant tumours during support with LVAD can be successfully resected. A multidisciplinary evaluation in these high-risk patients is mandatory. After careful evaluation, regaining the patient's heart transplant candidacy is possible.

Cited by 10 publications

References 20 publications

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

Cancer diagnosis in patients with heart failure: epidemiology, clinical implications and gaps in knowledge

Anthracyclines in a patient with acute leukemia and severe cardiomyopathy requiring mechanical support: A case report

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

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