1
|
Zaliznyak M, Stern L, Cole R, Shen A, Nishihara K, Runyan C, Fishman A, Olanisa L, Olman M, Singer-Englar T, Luong E, Cheng S, Moriguchi J, Kobashigawa J, Esmailian F, Kittleson MM. Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work? ASAIO J 2022; 68:499-507. [PMID: 34074853 DOI: 10.1097/mat.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Michael Zaliznyak
- From the Departments of Cardiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Oishi H, Kondo T, Kawamura M, Shimada K, Mutsuga M, Kurokawa T, Kuwayama T, Hiraiwa H, Morimoto R, Okumura T, Nishida T, Kiyoi H, Naganawa S, Usui A, Murohara T. Methods for confirming the safety of radiation therapy in patients with left ventricular assist device: a case of extranodal NK/T-cell lymphoma, nasal type. J Artif Organs 2022; 25:274-278. [PMID: 35113274 DOI: 10.1007/s10047-022-01312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
A left ventricular assist device (LVAD) is a treatment option for patients with end-stage heart failure; however, a certain number of patients on durable LVADs are diagnosed with malignancy. Radiation therapy (RT) for patients with durable LVADs has safety concerns, because RT may interfere with the device. Herein, we report a case of RT during durable LVAD management. A 48-year-old man with a durable LVAD was diagnosed with sinusitis. As his symptoms were resistant to drug therapy, endoscopic sinus surgery was performed, and extranodal NK/T-cell lymphoma, nasal type (ENKL) was pathologically detected. Since RT was the first-line treatment for ENKL, we conducted two types of irradiation experiments to determine whether RT can be safely performed in patients with durable LVADs as follows: (1) assessing the extent of the radiation levels at each site and evaluating device malfunction by irradiating the lesion sites in the patient model with the same protocol as planned, and (2) evaluating device malfunction by directly irradiating the durable LVAD equipment once at the scheduled total dose. The radiation doses at the pump, driveline, system controller, power cable, and power module of the durable LVAD reached 7.86 cGy, 6.34 cGy, 0.66 cGy, 0.38 cGy, and 0.14 cGy, respectively. In both experiments, durable LVAD malfunction or any type of alarm was not observed. We concluded that RT could be safely performed with chemotherapy in this patient and our irradiation experiments can be applied to RT for other malignancies.
Collapse
Affiliation(s)
- Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Mariko Kawamura
- Department of Radiology/Interventional and Therapeutic Radiology/Radiation Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Kurokawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuya Nishida
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology/Interventional and Therapeutic Radiology/Radiation Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
3
|
Banerjee R, Lo M, Klein L, Aras M, Logan AC. Anthracyclines in a patient with acute leukemia and severe cardiomyopathy requiring mechanical support: A case report. J Oncol Pharm Pract 2021; 28:729-732. [PMID: 34846217 DOI: 10.1177/10781552211062148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Rahul Banerjee
- Division of Hematology/Oncology, Department of Medicine, 8785University of California San Francisco, San Francisco, California, USA
| | - Mimi Lo
- Division of Hematology/Oncology, Department of Pharmacy, 8785University of California San Francisco, San Francisco, California, USA
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, 8785University of California San Francisco, San Francisco, California, USA
| | - Mandar Aras
- Division of Cardiology, Department of Medicine, 8785University of California San Francisco, San Francisco, California, USA
| | - Aaron C Logan
- Division of Hematology/Oncology, Department of Medicine, 8785University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
4
|
Sato GE, Matsuo Y, Kanemitsu H, Minatoya K, Nakajima D, Date H, Nakagawa Y, Mizowaki T. Safe Delivery of Postoperative Radiotherapy for Thymic Carcinoma Located on the Outflow Graft of a Left Ventricular Assist Device. JTO Clin Res Rep 2021; 2:100101. [PMID: 34589971 PMCID: PMC8474406 DOI: 10.1016/j.jtocrr.2020.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Genki Edward Sato
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan.,Department of Radiation Oncology, Shiga General Hospital, Moriyama City, Shiga, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hideo Kanemitsu
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Yasuaki Nakagawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| |
Collapse
|
5
|
Schlam I, Lee AY, Li S, Sheikh FH, Zaghlol R, Basyal B, Gallagher C, Molina E, Mahr C, Cheng RK, Barac A. Left Ventricular Assist Devices in Patients With Active Malignancies. JACC CardioOncol 2021; 3:305-315. [PMID: 34396339 PMCID: PMC8352017 DOI: 10.1016/j.jaccao.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There are limited data to guide oncology and cardiology decision-making in patients with a left ventricular assist device (LVAD) and concurrent active malignancy. OBJECTIVES The goal of this study was to describe cancer treatment approaches, complications, and survival among patients with active cancer on LVAD support in 2 tertiary heart failure and oncology programs. METHODS In this retrospective cohort study, LVAD databases were reviewed to identify patients with a cancer diagnosis at the time of or after LVAD implantation. We created a 3:1 matched cohort based on age, sex, etiology of cardiomyopathy, LVAD implant strategy, and INTERMACS profile stratified by site. Kaplan-Meier analysis and Cox proportional hazards models were used to compare survival between patients with cancer and non-cancer comparators. RESULTS Among 1,123 patients who underwent LVAD implantation between 2005 and 2019, 22 patients with LVADs with active cancer and 66 matched non-cancer comparators were identified. Median age was 62 years (range 41 to 73 years); 50% of patients with cancer were African-American, and 27% were women. Prostate cancer, followed by renal cell cancer and hematologic malignancies were the most common diagnoses. There was no significant difference in unadjusted Kaplan-Meier median survival estimates from the time of LVAD placement between patients with cancer (3.53 years; 95% confidence interval [CI]: 1.41 to 5.33) and non-cancer comparators (3.03 years; 95% CI: 1.83 to 5.26; log-rank P = 0.99). In Cox proportional hazard models, cancer diagnosis as a time-varying variable was associated with a statistically significant increase in death (hazard ratio: 2.05; 95% CI: 1.03 to 4.12; P = 0.04). Patients with cancer had less gastrointestinal bleeding compared with matched non-cancer comparators (P = 0.016). Other complications were not significantly different. CONCLUSIONS Our study provides initial feasibility and safety data and set a framework for multidisciplinary team management of patients with cancer and LVADs.
Collapse
Affiliation(s)
- Ilana Schlam
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Andy Y. Lee
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Song Li
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Farooq H. Sheikh
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Raja Zaghlol
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC, USA
| | - Binaya Basyal
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Christopher Gallagher
- MedStar Washington Cancer Institute, Washington, DC, USA
- Department of Hematology-Oncology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ezequiel Molina
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| | - Claudius Mahr
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Richard K. Cheng
- Department of Cardiology, University of Washington Medical Center, Department of Cardiology, Seattle, Washington, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Georgetown University, Washington, DC, USA
| |
Collapse
|
6
|
Maynes EJ, Gordon JS, Weber MP, O'Malley TJ, Bauer TM, Wood CT, Morris RJ, Samuels LE, Entwistle JW, Massey HT, Tchantchaleishvili V. Development of malignancies and their outcomes in patients supported on continuous-flow left ventricular assist devices-a systematic review. Ann Cardiothorac Surg 2021; 10:301-310. [PMID: 34159112 DOI: 10.21037/acs-2020-cfmcs-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background With increased use of continuous-flow left ventricular assist devices (CF-LVAD), development of malignant tumors in this population is not uncommon. We sought to evaluate malignancies in CF-LVAD patients and evaluate the outcomes of treatment strategies. Methods Overall, 18 articles consisting of 28 patients were identified who developed malignancies after CF-LVAD placement. Patient-level data were extracted for systematic review. Results Median patient age was 60 years [59-67] and 85.7% (24/28) were male. CF-LVAD was placed as bridge-to-transplant (BTT) in 60.9% (14/23) of patients. The three most common malignancy types were GI in 35.7% (10/28) of patients, lung in 21.4% (6/28) and skin in 10.7% (3/28). Median time from CF-LVAD implant to malignancy diagnosis was 6.9 [2.5-12.8] months. Metastatic disease occurred in 17.9% (5/28) over a median time of 5.0 [1.0-82.0] months from the diagnosis. Surgical resection of the malignancy was performed in 57.1% (16/28) of patients. Our results showed that while there was a significantly higher probability of survival among patients who underwent surgery versus those who did not, when only stage I and II patients were included in the analysis, this difference was no longer statistically significant. Three patients were relisted for heart transplant after surgical treatment, and two received the transplant. Conclusions Surgical management of malignancies in patients on CF-LVADs may improve survival and transplant eligibility status, therefore, a CF-LVAD should not always preclude surgical treatment.
Collapse
Affiliation(s)
- Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Gordon
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Matthew P Weber
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas J O'Malley
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tyler M Bauer
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chelsey T Wood
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Louis E Samuels
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John W Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
7
|
Gimenez De Lorenzo R, Navarra R, Marinelli D, Adorante N, Giancaterino S, Di Carlo C, Di Biase S, Rosa C, Falco MD. Effects of high-energy photon beam radiation therapy on Jarvik 2000 LVAD: in vitro evaluation. Radiol Med 2020; 125:561-568. [PMID: 32067164 DOI: 10.1007/s11547-020-01154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Left ventricular assist device (LVAD) is considered a standard care for patients with advanced heart failure. The aim of this work was to study in vitro the effects of direct exposure of the Jarvik 2000 LVAD to 10-MV photon beams. METHODS Jarvik 2000 pump was immersed in a siliconized box filled with deionized water. A 30 × 30 × 15 cm RW3 slabs were added forth and back to the box. A treatment plan consisting of a single direct 10 × 10 cm2 field size beam was used to deliver 1000 MU at the center of the pump. During irradiation, the external Flow Maker controller and the lithium battery were positioned away from the beam. Pump parameter data (included voltage, current and frequency) were measured, recorded and analyzed for changes in pump function among baseline, pre-irradiation, during irradiation, post-irradiation and after 6 months. The whole session lasted 6 months. The Mann-Whitney U test was used to compare the repeated measurements. X-ray radiation attenuation was also studied. RESULTS The parameters investigated remained stable over the 6 months; that is, no pump stops, alarms, events, operational changes or abnormalities during the discharge rate of the connected power sources, were encountered, confirmed by the Mann-Whitney U test applied to all sessions (p > 0.1). The measured X-ray attenuation differed from the calculated one by TPS by 34%. CONCLUSION The Jarvik 2000 resulted stable under direct X-ray beam of 10-MV energy. Its strong attenuation, however, can affect dose deposition in the pump in TPS, and it must be taken into account.
Collapse
Affiliation(s)
- Ramon Gimenez De Lorenzo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Riccardo Navarra
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.,Department of Neuroimaging and Cognitive Science, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Daniele Marinelli
- Department of Cardiac Surgery, University of Chieti "G. D'Annunzio", Chieti, Italy
| | - Nico Adorante
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Stefano Giancaterino
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Clelia Di Carlo
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Saide Di Biase
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Consuelo Rosa
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy
| | - Maria Daniela Falco
- Department of Radiation Oncology, University of Chieti "G. D'Annunzio", SS. Annunziata Hospital, Chieti, Italy.
| |
Collapse
|
8
|
Donisan T, Balanescu DV, Palaskas N, Lopez-Mattei J, Karimzad K, Kim P, Charitakis K, Cilingiroglu M, Marmagkiolis K, Iliescu C. Cardiac Interventional Procedures in Cardio-Oncology Patients. Cardiol Clin 2020; 37:469-486. [PMID: 31587788 DOI: 10.1016/j.ccl.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD). Patients with cancer have generally been excluded from cardiovascular randomized clinical trials. Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs because of their minimally invasive nature. Patients with cancer are less likely to be treated according to societal guidelines because of perceived high risk. This article presents the specific challenges that interventional cardiologists face when caring for patients with cancer and the modern tools to optimize care.
Collapse
Affiliation(s)
- Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/TDonisan
| | - Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA. https://twitter.com/dinubalanescu
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Kaveh Karimzad
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA
| | - Konstantinos Charitakis
- Department of Cardiology, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, Arkansas Heart Hospital, 1701 South Shackleford Road, Little Rock, AR 72211, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1451, Houston, TX 77030, USA.
| |
Collapse
|
9
|
Spano G, Stutz E, Elicin O, Hugi B, Henzen D, Fürholz M, Wieser M, Rhyner D, Dobner S, Pavlicek-Bahlo M, Robson D, Nadel J, Hayward C, Hunziker L, Martinelli M, Schnegg B. Is it safe to irradiate the newest generation of ventricular assist devices? A case report and systematic literature review. Artif Organs 2019; 44:449-456. [PMID: 31769042 DOI: 10.1111/aor.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/04/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022]
Abstract
An increasing number of mechanical assist devices, especially left ventricular assist devices (VADs), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published, most of them on HeartMate II (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3 (HM3, Abbott) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypofractionated radiotherapy due to an early-stage non-small-cell lung cancer. The patient did not suffer from any complications, including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in vitro studies and cases series are needed to reinforce this statement.
Collapse
Affiliation(s)
- Giancarlo Spano
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emanuel Stutz
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beate Hugi
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Henzen
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Fürholz
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Monika Wieser
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Rhyner
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Dobner
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maryam Pavlicek-Bahlo
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Desiree Robson
- Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - James Nadel
- Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Christopher Hayward
- Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lukas Hunziker
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michele Martinelli
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bruno Schnegg
- Center for Advanced Heart Failure, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
The Role of Rehabilitation Medicine in Managing Cardiopulmonary Complications of Cancer. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Gossman MS, Graham JD, Torres P, Kritzer D, Coutinho L, Tamez D. Evaluation of the MVAD pump: stability under high dose x-ray and proton radiation. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/2/025014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Will the influential diagnosis please stand up: managing the LVAD patient with cancer. ASAIO J 2014; 60:498-501. [PMID: 25166732 DOI: 10.1097/mat.0000000000000136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|