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Successful bridge to recovery with VAD implantation for anthracycline-induced cardiomyopathy

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Abstract

Anthracyclines are effective antineoplastic drugs, but they are known to be cardiotoxic. Recovery of cardiac function is rare. A few studies on implantation of a ventricular assist device (VAD) have been performed for anthracycline-induced cardiomyopathy. Recovery of left ventricular (LV) function with an LVAD is also rare. Recently, several adjunctive therapies were attempted to restore ventricular function. We report a successful bridge to recovery of ventricular function using VAD implantation for anthracycline-induced cardiomyopathy. The patient was a 57-year-old man who had been diagnosed with diffuse large B-cell lymphoma (DLBCL) at age 52. Combination chemotherapy including hydroxydaunorubicin was started. Complete remission was achieved after chemotherapy. Heart failure symptoms such as fatigue, dyspnea on exertion, and weight gain appeared 5 months later. A cardiac resynchronization device was implanted. His heart function deteriorated. He underwent implantation of a Toyobo LVAD and mitral annuloplasty. After implantation, he was prescribed carvedilol with spironolactone. He was weaned from the LVAD on postoperative day (POD) 239 and discharged on POD 37 after weaning. He remained in New York Heart Association classes within the first- to second-degree range, the LV dimention diastolic/systolic ratio was 56/46 mm, ejection fraction 38%, and mitral regurgitation mild at 3 years after weaning from the LVAD. Our patient could be weaned from LVAD probably due to the combination management strategy employing mitral valvuloplasty, use of cardiac resynchronization therapy, and taking carvedilol with spironolactone. Further studies will be needed to clarify the efficacy of these adjunctive therapies.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Chitaru Kurihara, Kan Nawata, Osamu Kinoshita, Noboru Motomura & Minoru Ono

  2. Department of Therapeutic Surgery for Heart Failure, The University of Tokyo, Tokyo, Japan

    Takashi Nishimura, Motoyuki Hisagi & Shunei Kyo

Authors
  1. Chitaru Kurihara
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  2. Takashi Nishimura
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  3. Kan Nawata
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  4. Osamu Kinoshita
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  5. Motoyuki Hisagi
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  6. Noboru Motomura
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  7. Shunei Kyo
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  8. Minoru Ono
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Correspondence to Chitaru Kurihara or Takashi Nishimura.

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Kurihara, C., Nishimura, T., Nawata, K. et al. Successful bridge to recovery with VAD implantation for anthracycline-induced cardiomyopathy. J Artif Organs 14, 249–252 (2011). https://doi.org/10.1007/s10047-011-0567-7

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  • DOI: https://doi.org/10.1007/s10047-011-0567-7

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