Recovery of Ventricular Function With a Left Ventricular Axial Pump in a Patient With End-Stage Toxic Cardiomyopathy Not a Candidate for Heart Transplantation: First Experience in Spain

Castells, E; Roca, Josep; Miralles, Albert; Manito, Nicolás; Ortiz, Daniel; Gonzalez, J.; Granados, J; Benito, Mónica; Rabasa, Marc Millan; Sbraga, Fabrizio; Toscano, J.; Toral, David; López, Anna; Fontanillas, C.

doi:10.1016/j.transproceed.2009.06.029

Cited by 15 publications

(13 citation statements)

References 7 publications

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“…These devices have been used to rescue cancer survivors from acute decompensated heart failure or as a bridge to transplantation in patients with end-stage heart failure. [553][554][555] The best time to implant a mechanical assist device has not yet been defined in children in heart failure or specifically in survivors of childhood cancer. The risk of adverse events with mechanical assist devices, including infection, thrombosis, bleeding, and neurological impairment, can be as high as 40%.…”

Section: Heart Failure Stage D: Patients In Heart Failure Refractory mentioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

494

436

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Section: Heart Failure Stage D: Patients In Heart Failure Refractory mentioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

494

436

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“…Only a few reports have been published about LVAD implantation for severe HF due to anthracycline use. [34][35][36][37] Recovery of ventricular function in LVAD patients who have anthracycline-induced cardiomyopathy is rare. Castells and colleagues 35 described the case of a patient with end-stage HF due to anthracycline and trastuzumab cardiomyopathy, who underwent implantation of an LV axial pump; the patient's condition improved, and the pump was explanted at 135 days.…”

mentioning

confidence: 99%

“…[34][35][36][37] Recovery of ventricular function in LVAD patients who have anthracycline-induced cardiomyopathy is rare. Castells and colleagues 35 described the case of a patient with end-stage HF due to anthracycline and trastuzumab cardiomyopathy, who underwent implantation of an LV axial pump; the patient's condition improved, and the pump was explanted at 135 days. In addition, Freilich and colleagues 36 described the case of a 16-year-old girl who recovered from doxorubicin-induced cardiomyopathy after long-term LVAD support.…”

mentioning

confidence: 99%

Anthracycline Treatment and Ventricular Remodeling in Left Ventricular Assist Device Patients

Segura¹,

Radovancevic²,

Demirozu³

et al. 2015

Texas Heart Institute Journal

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Nonischemic cardiomyopathy can complicate antineoplastic therapy and lead to irreversible heart failure. We evaluated structural changes at the time of left ventricular assist device implantation in heart failure patients who had been exposed to anthracycline, and we correlated those changes with clinical presentation. We retrospectively studied left ventricular core samples taken at implantation of the HeartMate II left ventricular assist device in 12 heart failure patients (mean age, 46 ± 16 yr) who had histories of anthracycline exposure. We evaluated those samples for hypertrophy, myocytolysis, and fibrosis. Histopathologic findings showed moderate-to-severe myocyte hypertrophy, moderate myocytolysis, and perivascular and interstitial fibrosis with areas of replacement fibrosis. Ultrastructural studies revealed marked decreases in myofibrils, diffuse mitochondrial swelling, and disorganization of the sarcoplasmic reticulum. The interval between anthracycline therapy and heart failure was a mean of 6.8 ± 5.7 years; duration of heart failure symptoms, 38 ± 47 months; and duration of device support, 414 ± 266 days. Four patients are continuing on device support, 3 have undergone transplantation, 3 have undergone device explantation, and 2 have died. The time of heart failure onset and the duration of symptoms did not correlate with the severity and extent of the histopathologic changes. The histopathologic findings and the clinical course varied in heart failure patients with anthracycline exposure. No correlation was observed between anthracycline therapy and the development or duration of heart failure symptoms, severity of histopathologic changes, or outcomes.

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“…[1][2][3] Protocols for device selection, home discharge, outpatient monitoring, and adequate evaluation for myocardial recovery and decision algorithms for device explantation are missing or have to be generated for this specific patient group.…”

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confidence: 99%

VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

et al. 2014

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This report describes an 8-year-old child with acute anthracyclineinduced cardiomyopathy triggered by human herpesvirus 6 and the subsequent implantation of an intracorporeal continuous-flow left ventricular assist device (LVAD) and the process to discharge the child from the hospital. After barely 3 months on mechanical support, the device was explanted after thorough examination. Experiences regarding LVAD removal are limited, and no guidelines for echocardiographic and hemodynamic criteria for LVAD removal in children have been published thus far. We present our institutional algorithm for device selection, surveillance in an ambulatory setting, and testing for myocardial recovery, as well as our criteria for LVAD explantation in children. Pediatrics 2014;134:e894-e899 Drs Cavigelli-Brunner and Schweiger conceptualized and designed the study, drafted the initial manuscript, and were involved in the direct care of the patient described; Dr Knirsch drafted the initial manuscript and supervised and critically reviewed the manuscript; Dr Stiasny reviewed and revised the manuscript and was involved in the direct care of the patient described; Dr Klingel critically reviewed and revised the manuscript; Drs Kretschmar and Hübler supervised and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. Experiences with intracorporeal left ventricular assist devices (LVADs) in children suffering from anthracyclineinduced cardiomyopathy (CMP) with subsequent myocardial recovery and LVAD explantation are rare. 1-3 Protocols for device selection, home discharge, outpatient monitoring, and adequate evaluation for myocardial recovery and decision algorithms for device explantation are missing or have to be generated for this specific patient group.We describe the use of an intracorporeal continuous-flow LVAD in a child with acute heart failure due to anthracycline-induced CMP triggered by human herpesvirus 6 (HHV6), her subsequent discharge home, and successful device explantation after 149 days on support. CASE REPORTAn 8-year-old girl (body weight: 25 kg; body surface area [BSA]: 0.97 m 2 ) was admitted to our hospital due to severe, rapid-onset heart failure. Seven months before, she had been diagnosed with a bone sarcoma of the left tibia and was treated by surgical resection and chemotherapy according to the EURAMOS-1 Trial (The European and American Osteosarcoma Study Group), including methotrexate, cisplatin and doxorubicin(cumulative doses: 450 mg/m 2 ). Ten days after the last chemotherapy course, her general condition worsened, and echocardiography showed a dilated left ventricle, a biventricular reduced contractility with an ejection fraction (EF) of 25%, and a shortening fraction of 15%. Despite maximal inotropic support and mechanical ventilation, the patient' s condition deteriorated, and an LVAD implantation with the use of an LVAD HeartWare Ventricular Assist System (HeartWare Inc, Framingham, MA) was successfully performed (Fig 1).Apart from prolonged medical sup...

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Recovery of Ventricular Function With a Left Ventricular Axial Pump in a Patient With End-Stage Toxic Cardiomyopathy Not a Candidate for Heart Transplantation: First Experience in Spain

Cited by 15 publications

References 7 publications

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Anthracycline Treatment and Ventricular Remodeling in Left Ventricular Assist Device Patients

VAD as Bridge to Recovery in Anthracycline-Induced Cardiomyopathy and HHV6 Myocarditis

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