Recovery from anthracycline-induced cardiomyopathy with biventricular assist and valve repairs: A case report and literature review

Abstract

Introduction:

Ventricular assist device is used in the patients with severe heart failure due to cardiotoxicity of anthracyclines, which are widely used chemotherapeutic agents for a wide range of malignant tumors. However, recovery of cardiac function is rare.

Methods:

We present the clinical course of a 43-year-old woman in remission from diffuse large B-cell lymphoma after the chemotherapy including anthracyclines, who presented in cardiogenic shock 8 months after the end of chemotherapy.

Results:

The patient was initially treated with intra-aortic balloon pumping, followed by conversion to left ventricular assist device with an Abiomed AB5000 (Abiomed, Inc, Danvers, MA) and right ventricular assist device with a centrifugal pump and a membrane oxygenator, in addition to tricuspid annuloplasty, due to rapid deterioration to cardiogenic shock. With intensive medical treatments during biventricular support, her cardiac and respiratory functions gradually improved, although moderate mitral regurgitation persisted despite of left ventricular unloading. At 64 days of biventricular support, she underwent mitral valve annuloplasty to correct regurgitation under cardiopulmonary bypass. She was consequently weaned from biventricular assist successfully 8 days after mitral surgery (72 days of biventricular support). The patient discharged uneventfully from our hospital and survives at home 12 months after weaning from the ventricular assist devices.

Conclusion:

Our case and the literature review highlight potential usefulness of aggressive mechanical biventricular support for cardiac recovery in patients with anthracycline-induced cardiomyopathy. Additional valve surgery and neurohormonal medications may be also promising in such patients with cancer, who are contraindicated for heart transplantation.

Keywords

Anthracycline cardiomyopathy recovery biventricular assist device

Get full access to this article

View all access options for this article.

References

McGowan

Chung

Maulik

et al . Anthracycline chemotherapy and cardiotoxicity. Cardiovasc Drugs Ther 2017; 31(1): 63–75.

Cardinale

Colombo

Bacchiani

et al . Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation 2015; 131(22): 1981–1988.

Volkova

Russell

3rd . Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev 2011; 7(4): 214–220.

Chatterjee

Zhang

Honbo

et al . Doxorubicin cardiomyopathy. Cardiology 2010; 115(2): 155–162.

Swartz

Fink

Carhart

Jr . Use of a biventricular assist device in the treatment of acute doxorubicin-induced cardiotoxicity. Congest Heart Fail 2004; 10(4): 197–199.

Zhang

Liu

Bawa-Khalfe

et al . Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med 2012; 18(11): 1639–1642.

Freilich

Stub

Esmore

et al . Recovery from anthracycline cardiomyopathy after long-term support with a continuous flow left ventricular assist device. J Heart Lung Transplant 2009; 28(1): 101–103.

Castells

Roca

Miralles

et al . 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. Transplant Proc 2009; 41(6): 2237–2239.

Kurihara

Nishimura

Nawata

et al . Successful bridge to recovery with VAD implantation for anthracycline-induced cardiomyopathy. J Artif Organs 2011; 14(3): 249–252.

10.

Khan

Husain

et al . Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device. Tex Heart Inst J 2012; 39(4): 554–556.

11.

Appel

Sander

Hansen

et al . Left ventricular assist device as bridge to recovery for anthracycline-induced terminal heart failure. Congest Heart Fail 2012; 18(5): 291–294.

12.

Segura

Radovancevic

Demirozu

et al . Anthracycline treatment and ventricular remodeling in left ventricular assist device patients. Tex Heart Inst J 2015; 42(2): 124–130.

13.

Cavigelli -Brunner

Schweiger

Knirsch

et al . VAD as bridge to recovery in anthracycline-induced cardiomyopathy and HHV6 myocarditis. Pediatrics 2014; 134(3): e894–e899.

14.

Madigan

Barbone

Choudhri

et al . Time course of reverse remodeling of the left ventricle during support with a left ventricular assist device. J Thorac Cardiovasc Surg 2001; 121(5): 902–908.

15.

Patel

Saeed

Murthy

et al . Combining neurohormonal blockade with continuous-flow left ventricular assist device support for myocardial recovery: a single-arm prospective study. J Heart Lung Transplant 2013; 32(3): 305–312.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB