Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

Patel, Angira; Joong, Anna; Lelkes, Efrat; Gossett, Jeffrey G.

doi:10.1001/amajethics.2019.380

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…9,10 The literature specifically addressing the use of durable VAD support in children with HF and a recent history of cancer is limited to case reports. [9][10][11][12][13][14] There are no guidelines on how to proceed in pediatric patients who develop worsening HF after recently completing their cancer treatment, and the ISHLT advocates for individualized risk stratification for cancer recurrence in collaboration with oncologists. 15 In this manuscript, we review our single-center experience of durable VAD support for advanced HF in 6 children with chemotherapy-induced cardiomyopathy.…”

Section: Introductionmentioning

confidence: 99%

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

Puri

Denfield

Adachi

et al. 2022

Pediatric Transplantation

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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.

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