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

Abstract

Background: Guidance and data on ventricular assist device (VAD) support for children with chemotherapy-induced cardiomyopathy, particularly within the first 2 years after chemotherapy, are limited. Methods:We performed a single-center retrospective case series, reviewing medical records of children <18 years of age with chemotherapy-induced cardiomyopathy and advanced heart failure (HF) who received durable VAD support.Results: Six patients met inclusion criteria-5 HeartWare™ HVAD, 1 Berlin Heart EXCOR ® . Median age at cancer diagnosis was 6 years (IQR 4.5-10 years). Median dose of anthracycline received was 540 mg/m 2 (IQR 450-630 mg/m 2 ). All patients developed HF within 1 year after initiation of cancer treatment (median 8 months, IQR 6-11.5 months) and were initiated on durable VAD support at a median of 8 months after completion of cancer treatment (IQR 3.3-43.5 months). 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 7.5 months (IQR 3-11.3 months). Two patients underwent VAD explant due to recovery of LV function, one died due to cancer progression, and three underwent heart transplantation. Conclusions:Durable VAD support should be considered as a therapeutic option for children who have advanced HF due to chemotherapy-induced cardiomyopathy, even within 2 years 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.

Material also matters: Mechanical bridge to heart transplantation in pediatric cancer survivors

“…In this issue of the journal, Puri and colleagues 1 There are tentative indications that fitting the larger device in the thorax of smaller patients may not be the main problem, but rather the fact that the HeartMate III™ requires a minimum cardiac output of 2.5 L/min, which may lie above a 25 kg child's physiological cardiac output and must also be stemmed by the right ventricle.…”

“…In this issue of the journal, Puri and colleagues 1 describe their retrospective single‐center experience with ventricular assist devices (VAD) in six pediatric patients aged 4–13 years suffering from advanced stage chemotherapy‐induced cardiomyopathy. Five of these received the world's smallest centrifugal VAD, the Medtronic HeartWare HVAD™, and the youngest patient the pneumatically driven pulsatile Berlin Heart EXCOR ® .…”