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Troponin Elevation in Patients Undergoing Percutaneous Hepatic Perfusion for Metastatic Uveal Melanoma.
Chandrasekhar, Sanjay; Perez, Matthew; Niaz, Zurain; Ekram, Jahanzaib; Lal, Neelam; Koly, Sarah; Cao, Biwei; Zager, Jonathan S; Alomar, Mohammed.
Afiliação
  • Chandrasekhar S; Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
  • Perez M; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
  • Niaz Z; Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
  • Ekram J; Division of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
  • Lal N; Department of Cardio-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
  • Koly S; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
  • Cao B; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
  • Zager JS; Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
  • Alomar M; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Cancer Control ; 31: 10732748241246898, 2024.
Article em En | MEDLINE | ID: mdl-38605434
ABSTRACT

BACKGROUND:

Percutaneous Hepatic Perfusion (PHP) is a liver directed regional therapy recently FDA approved for metastatic uveal melanoma to the liver involving percutaneous isolation of liver, saturation of the entire liver with high-dose chemotherapy and filtration extracorporeally though in line filters and veno-venous bypass. The procedure is associated with hemodynamic shifts requiring hemodynamic support and blood product resuscitation due to coagulopathy.

OBJECTIVE:

To assess the cardiac safety and subsequent clinically significant sequalae of this therapy.

METHODS:

Consecutive PHP procedures done at our center between 2010-2022 were assessed retrospectively. Cardiac risk factors, post procedural cardiac enzymes, electrocardiograms, and transthoracic echocardiograms along with 90-day cardiac outcomes were reviewed. All data were reviewed by cardio-oncologists at our institution.

RESULTS:

Of 37 patients reviewed, mean age was 63 years and 57% were women. 132 procedures were performed with an average of 3.57 procedures per patient. 68.6% of patients had elevated troponin during at least 1 procedure. No patients were found to have acute coronary syndrome, heart failure, unstable arrhythmias, or cardiac death. No patients had notable echocardiographic changes. 10.8% of patients with positive troponin had asymptomatic transient electrocardiographic changes not meeting criteria for myocardial infarction. One patient had non-sustained ventricular tachycardiac intra-operatively which did not recur subsequently. Three patients died from non-cardiac causes within 90-days. There was no oncology treatment interruption, even in those with troponin elevation. In multivariable analysis, a history of hyperlipidemia was a predictor of postoperative troponin elevation. (P = .042).

CONCLUSION:

Percutaneous Hepatic Perfusion is safe and associated with a transient, asymptomatic troponin elevation peri-operatively without major adverse cardiac events at 90 days. The observed troponin elevation is likely secondary to coronary demand-supply mismatch related to procedural hemodynamic shifts, hypotension, and anemia.
Percutaneous hepatic perfusion using melphalan in patients with uveal melanoma and liver metastases carries no significant cardiac adverse events.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Uveais / Neoplasias Hepáticas / Melanoma / Melfalan Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Cancer Control Assunto da revista: NEOPLASIAS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Uveais / Neoplasias Hepáticas / Melanoma / Melfalan Limite: Female / Humans / Male / Middle aged Idioma: En Revista: Cancer Control Assunto da revista: NEOPLASIAS Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos